Self Care

Self care is a term we hear a lot now when mental health is mentioned on social media. What does it mean, though? What some would consider avoidance, others would view as a healthy activity that allows a person to take time out from the exhausting daily battle of living with a mental illness.

Essentially, what we're talking about is doing something that makes you feel good. When I first went to the doctors and was given a sick note for three weeks because of "stress at work" one of the most memorable things he said to me was "you need to do whatever it is that makes you feel good." As my "stress at work" gradually developed in to full blown severe depression followed by a steadily worsening anxiety, I started to realise that not many things do make me feel good these days. This isn't surprising considering one of the main symptoms of depression is to lose interest in things. So how do you provide yourself with one day of self care let alone #365daysofselfcare when you seem to have lost interest in everything? It's incredibly difficult. In fact, it's so difficult that if you don't have any personal experience of battling with depression, I'm not sure you can understand. Try to imagine hearing your favourite song but instead of feeling the emotions that gave it a special place in your life, you feel nothing or worse, you feel negative.

I'm going to stop at this point. Partly to change paragraphs as this bloggy style of writing does have a tendency to degenerate in to an unstructured rant, but mainly to emphasise what I've just said and to ask you to think about it really carefully. Try to imagine hearing your favourite song but instead of feeling some form of pleasure, you feel nothing, or worse, you feel negative. It's difficult, isn't it? How could that song not make you feel pleasure? One reason could be that the hippocampus, the part of your brain that deals with memory and emotion has started to shrink. Recent studies have shown this happens to people who suffer from depression and anxiety. This physical change can lead to significant disturbances in cognitive function and changes the way we process our emotions, so instead of feeling good about something we once enjoyed, we feel something negative. As somebody who has and does go through this on a daily basis, I can confirm it is confusing and at times terrifying. The one thing that keeps me going, is focusing on the fact that these feelings are being created by a physical change in the brain which is caused by a mental illness, so in that sense, they are not typically "natural" feelings.

What next, though? If the things you used to enjoy give you no pleasure, what are you supposed to do in terms of self care? This is something I struggle with but @blurtfoundations #365daysofselfcare campaign reminded me that even the smallest and seemingly least significant activity can make a massive difference to the way you feel. I do these things when I feel like I seriously need to focus on self care.

1. Meditate.

I don't burn incense or sit cross legged and barefoot on the floor while chanting and listening to wind chimes, but I do sit for 10 minutes and focus on the physical sensations, sounds and other non visual senses. All this does is provide me with an opportunity to "observe" how I'm feeling without being consumed by overwhelming negative thoughts. One of the main symptoms of my condition is that I sometimes feel detached from reality and don't really know how I'm feeling from one moment to the next. It's taken a lot of practice and honestly, some days I can't manage it, but when I do manage to meditate, it often allows me to acknowledge the fact that I feel depressed or anxious without spiralling in to a full blown panic attack or further negative thinking.

2. Put my health first.

This is probably the hardest part of the whole process. When I have established how I'm feeling, this stage is when I decided what I'm capable of doing. With things like work and money to consider, it can feel impossible to put your health before the never ending drive to acquire more currency or to cement your reputation in the professional world, but ignoring these feelings and just carrying on (or "manning up" as the truly ignorant might say) can make things far worse than you can imagine. The last time I tried to "man up" and just get on with things, I took a terrible minimum wage job in a callcentre to pay my way. Within three weeks I had been prescribed Valium for severe anxiety and been signed off work for two weeks. As I was working on a zero hour contract, that meant no pay. I'm sure I was entitled to statutory sick pay but I didn't feel capable of going through the process to claim for it. This step isn't really a solution, it's basically harm reduction. The financial problems that come with mental health problems could take up a full blog post on their own so I won't pretend I have any easy answers about that, but I will say that if you don't acknowledge the way you feel and put your health first, things will definitely get much worse. In other words, if you feel like crying, vomiting or hurting yourself when you think about going to work, it's probably time to do something to help yourself.

3. Accept that you're ill.
This can be a difficult stage as well. I can physically walk around, I can put one foot in front of the other and go to the kitchen to fill up a glass of water and microwave a bowl of soup, so surely I'll be able to leave the house and get on with my life as normal. No, this isn't the case, unfortunately. When depression really kicks in, doing things as simple as feeding and washing yourself become almost impossible. A trip to the bathroom requires half an hours planning and mental effort. Imagine you've just got back from a festival or you've just finished a race. Your body and mind are so fatigued that all you want to do is sleep. That's how it feels when you have depression. That's why it's not as simple as just "getting on with it." If you feel like this, accept it and try to understand that this is an illness, you are not being lazy or weak. It is not your fault. If you had a broken leg, you wouldn't be able to walk properly and more importantly, nobody would expect you to. When you have depression, you shouldn't be expected to function normally. Unfortunately, the world and indeed, the systems of financial and medical support we have need to catch up with this way of thinking but this is basically why it's ok for you to stop trying to pretend everything's alright when it really isn't.

4. Take care of the basics.
So now that you've accepted you are ill, there are a few things you can do to make sure things don't get a lot worse. Eating, drinking and washing are the three main ones. Even if you can only manage to microwave some soup, drink a glass of water and get in the shower for five minutes, it's important to prioritise these things if you can. If you're anything like me, it probably won't have an effect on your mood but it will mean you can avoid physical health problems that come from malnutrition and neglecting personal hygiene. Get fed, watered and clean every day and you're doing well. Seriously, that's a huge part of the process taken care of, so if you manage to do these things, reward yourself.

(If you can't manage to do these things and you feel like your health is deteriorating further, this would be the stage to seek further help from a friend, family member or a GP.)

5. Do something that makes you feel good.

This is the part of the process that is probably the most misunderstood and perhaps the reason that ignorant people label those with mental health problems lazy and weak. "Sitting around and doing things that make you feel good is all very nice but haven't you got work to be getting on with? I wish I could sit at home eating crisps and watching Netflix all day!" If you've ever returned to work after having time off for mental health problems, this is probably something you've heard. Not only is this attitude ignorant, it's also offensive. If somebody with a physical injury was confined to bed, it's unlikely people would say "I wish I got to have a sleep in and stay in bed all day." It doesn't really make sense. The pleasure of sleeping in and staying in bed is so vastly outweighed by the physical illness the thought wouldn't even cross our minds.

So at this point, even if it is difficult, it's important to understand that being kind to yourself and allowing yourself to do something that makes you feel good is not some kind of illicit, skivey treat, but actual treatment of your condition. By doing something you enjoy, you are allowing yourself the best chance for your brain to release the chemicals associated with pleasure and happiness and consequently, you are are also providing yourself with the best chance of recovery.

When things get so bad that you've lost interest in the things you used to enjoy, something that can allow you to feel pleasure is to engage in an activity you used to enjoy without expecting to feel anything positive. This can feel like as much of a struggle as anything else but it is often worth trying. I play old computer games, watch films I used to watch as a kid, listen to music, read fiction, eat sweets, text friends. Sometimes I manage to relax enough to forget about the illness for a while. It took me around a day and a half of pure anxiety to settle down recently but eventually, I did manage to feel calm enough to focus on something. After losing myself in an old computer game for a few hours I eventually managed a few smiles and one or two moments of genuine enjoyment. It might seem insignificant but by doing this, I've changed the way I feel for the better and taken control of a situation that felt previously unmanageable.

The world can seem like it's against people with mental health problems and people might even shout advice at you but it's important to remember to pay attention to how you really feel, then do something about it. As always, this was written in one go so I hope it makes sense and as always, if you are suffering with a mental health problem, I hope this post has helped in some way.

X

It's really not what you think.

It's been a while since my last blog post. I've been busy working from home and have found it pretty difficult to motivate myself to write anything that I'm not being paid for. It obviously takes up free time and effort, so the absence of any kind of tangible reward makes motivation hard to find at times.

This time, I'd like to talk about Mental Health services. Since moving to Manchester I've been on a waiting list for high intensity psychological therapy. After around 15 months I've finally spoken to a qualified psychologist who explained that I will need to wait another six months before I can begin the complex work that I need to do. In the interim, I've been referred to a mindfulness service. Something I feel quite positive about as my own experiences of using mindfulness to assess my moods has been quite effective. The psychologist I spoke to was brilliantly empathetic, extremely well qualified and listened carefully to my previous experiences of therapy and how I felt about them.

For those unfamiliar with talking therapy, there are a lot of different types. I've been through Cognitive Behavioural Therapy, Transactional Analysis, Person Centred and probably other types. Depending on a person's needs, each type of therapy can be extremely effective but can also create further problems if the main issues a patient needs to discuss are not addressed.

My experience of being assessed and referred to services might be helpful or at least interesting to anybody experiencing a similar situation.

Assessments often take place over the phone. You will be asked about how you feel each day in specific terms and usually to rate your experiences on a numbered scale. So for example, do you feel as if you would be better off dead or hurting yourself in some way. 1 being not at all, 9 being all the time.

This can be a very effective way of obtaining an overall picture of how a person may be feeling, however, the prescriptive nature of the process and the increase in the use of lower level practitioners can often lead to a dehumanised, impersonal and systematic approach to problems which are by their very nature, human and difficult to quantify.

Having suffered with severe depression and anxiety for over 7 years and having been through a range of different treatment options and still not, "fixed" I became very frustrated with the way things seemed to work. The services to help people with mental health issues do exist but unless your problem can be fixed by a short, six week block of sessions or an online tool, the chances are you will find them woefully inadequate to meet your needs.

The practitioners I've spoken to have been incredibly kind and well meaning. I've been told not to beat myself up so much, to be kinder to myself and to "lighten up." One of them even suggested I took a day trip to the seaside town of Whitby... (She was probably my least favourite.) The issue here is that after paying for some in depth psychological therapy, (transactional analysis) I have been able to ascertain some of the things that make me the way that I am. It was painful, difficult and exhausting, but it's also the reason I'm not dead and able to function in a job now, rather than lying in bed feeling numb or worse. The thing with that kind of therapy, is that it requires a practitioner who is very experienced or qualified to go in to a lot of depth with an individual. Most of the lesser qualified practitioners I have spoken to were very nice but some seemed to struggle with non standard English to such a degree, the process itself became almost as frustrating as the condition it was designed to treat.

One practitioner asked me; "So, how did you feel when you decided not to kill yourself." I replied with "indifferent." She said "different to what?" "No." I said. "Indifferent." "I don't know what you mean." She said. Now this isn't really anyone's fault, but that kind of situation shouldn't arise. Having the courage, patience and resilience to seek help and then go through the numerous assessment processes is a difficult enough experience for the individual involved without problems with communication from the practitioner who has been assigned to help  them.

So for now, I'm trying to keep up with mindfulness exercises and am looking forward to (that should probably read, nervously anticipating)  the day that my actual psychological therapy starts again. I know I shouldn't beat myself up and I know I shouldn't be so hard on myself, but if it was as simple as hearing somebody say that a few times, I'd have been "fixed" by my loving friends and family years ago. There is no easy solution to mental health issues, the fact is, it's a complicated and challenging area that requires an army of highly qualified medical professionals rather than lots of well meaning but less educated practitioners to tick some boxes and make it look as if something is being done.

 Kind words almost always help and probably more than you think, too. They aren't a substitute for actual medical treatment, though. That takes time, for the practitioner to understand the patient, money, to pay the wages of somebody who has a higher level (Masters or above) qualification in a relevant area and lastly, awareness. That's an ethereal word that doesn't mean very much to a lot of people. "Raising awareness" usually means wearing a ribbon or a bit of rubber around your wrist or maybe even not drinking for a while in return for sponsor money. Nobody seems especially "aware" of the cause they are campaigning for because the cause is usually a complex, difficult and nuanced entity that can't be reduced to a few simple words or phrases.  By "awareness" I mean a genuine, tacit understanding that mental health problems are as debilitating and as life threatening as physical ones and should therefore be given the same amount of money and time by our health service. If it seems unrealistic to assign a psychologist to everybody in the UK who has severe depression, I think you might begin to see the scale of the problem. I'm tired of feeling as if I should be grateful for inadequate treatment and I have a feeling I'm probably not the only one.

I'll probably write another one of these soon. As always, if you are going though any kind of mental health issue. I hope this has been helpful in some way. X