Mental Health Awareness, whether it’s a day or a book or a talk, the focus is largely on trying to achieve one of two things A. An end to the stigma that surrounds mental health and/or B. To raise awareness of the need for access for treatment and maybe even funding for treatment. Outside of these 2 campaigning points there’s usually a huge focus on getting people to accept their illness. All three things are pivotal if we are going to march towards eliminating mental health issues like we do HIV, Cancer and Dementia, but I have noticed something lacking, even when the buzz is at its highest during World Mental Health Day, where’s the “what you can do” rallying cry? The demand that together we can beat it? The unabashed demand for money for research? For solidarity? Facebook, bloggers, vloggers and friends moved me this week with their posts in support of such an important day, but the tone was a little subdued. There were gentle reminders of compassion, empathy, “until you walk in their shoes” type stuff, but no real hard hitting advice on how you, if you are not suffering with a mental health issue, have as much responsibility to be the lynch pin that holds shit together for someone with a mental health illness as you do for someone with a physical illness. I think it’s time we opened up the conversation about how the healthy, the family, the friends, the lovers, the employers and the society around someone with a mental health issue can be supportive.
- Don’t pass it off as, “normal” just because you think you have a shared experience
I have 2 scenarios for you: The first is for women, if you met someone who doubled up with stomach pain regularly, would you flippantly say, “all women get like that, think about how bad period pain is, doesn’t mean anything is wrong” without any real knowledge about frequently they experienced the pain or whether it had anything to do with periods?
The second, if you are a guy, you are talking to a friend who is pretty low about how he hasn’t been able to get an erection would you say, “happens to everyone when they are drunk, no big deal” regardless of how frequently your friend was afflicted by it or if alcohol was involved?
Unless you’re highly insensitive, I doubt it. Use that same sense of rational discretion in just being flippant about emotional issues too and the world would be a better place! It is very easy to dismiss mental health problems on the basis of thinking we all share those feelings but some of us just choose to lie down in them.
“We all get down”
“You just have to keep fighting, be strong”
“People have it a lot worse than you and cope”
“Most people can’t sleep when they are bothered about something” “I can’t eat anything before a job interview”
“all girls go through phases of hating the way they look”
“it’s just part of growing up”
“boys are gonna fight, boys will be boys”
“you just like feeling like you know what’s going on, nobody likes feeling like they don’t have control”
Words have power. I have no idea of the percentage, but let’s assume 100% of people would fear being diagnosed with Cancer, let’s also assume the same percentage of people don’t want to face a lifelong label of a mental health illness… Words will make people with a lump they’ve been ignoring go to a doctor; no one who loved someone ever said, “just ignore that lump, you’re right, it’s probably nothing, no big deal it’s getting worse”. But many of the same people will turn to another person they love and tell them it’s just a bad day, even if those bad days have been getting more frequent. From personal experience, I hung on every one of those affirmations that I was ok, even when in the back of my mind I could see that the balance of good and bad days, feelings and thoughts had shifted way beyond what was normal and healthy. When you are suffering with very low mood you often don’t like or trust yourself, you don’t see the value in your own beliefs but you might hang on the words of others as you value them more than yourself.
- Don’t fall in love with someone, or find someone incredibly sexy, because you think they are a broken thing you can fix.
I know, what a horrible thing to say! How does this have anything to do with mental health? Quite simply actually, we all know someone who feels better about themselves when helping someone else. That trait, in itself, is not the problem, some incredibly inspiring people have dedicated their lives to bettering those of others, but it can spawn 2 dangerous side effects. The first, the ill person will not get professional help, the second, you will enable them to get worse and make recovery more difficult.
So, how to challenge this?
Well, a crude observation, if someone is an insane lover but a wreck outside of that, don’t just help them fuck the pain away. Sex, drugs, drink… What do they have in common? All of them are a great way to escape. Sex is so physical and so demanding it is a very good way to distract someone from the thoughts in their head, from the nervous energy running through their body or from the long dark hours of sleeplessness. Sex is a great way to bring someone back into the moment when their mind has been off in long labyrinth of thoughts that stop them being present for huge chunks of the day. You can’t really guess someone is depressed when they are fucking like a pro, but that’s because often people assume depression is someone in bed all day, someone who can’t raise a smile, someone who has no opinions and is generally dull, a vanilla ice cream, luke warm tea type. This image is ridiculous and ignorant; remove it from your mind! From now on, let’s not forget Robin Williams killed himself. Let’s try to remember Robin Williams throughout dialogues about mental health and recall his wit, charisma, charm, impeccable sense of timing and sharp tongue… He was still ill.
A lot of people have heard someone make a comment about how, “crazy” or “needy” the girl they are sleeping with is but how great the sex is. To me, that’s cruel anyway, it’s not really cool to claim bragging rights about sex (especially when everyone does it, including your parents!) but it verges on abusive to use someone you are so casually able to talk about as not being ‘normal’. Just because someone can take the time to make themselves up, have the energy to dance all night and then go home with you, doesn’t mean they are not struggling. If red flags start waving at a later date, don’t ignore them because they don’t fit your narrow idea of what depression looks like. Think Cara Delevingne.
We all know that girls are actively sent the message that their worth is in their bodies, but it’s also pretty accepted that a damsel in distress in sexy, that a knight in shining armour is admirable, we need to stop this madness. Now. If from a very young age girls subconsciously believe that they are not emotionally equipped to rely on themselves to navigate their choices around their own best interests, then they will frequently fail to do so.
We all know the prince and princess stereotypes are ridiculous, yet princess clothing, slogans and identities are still indulged, I don’t see as many little prince shirts floating around, but the idea of a girl being spoilt, superficial and needing waiting on is indulged.
Apart from that little aside, gender norms are damaging. If we tell girls a guy can save them and guys that they can be the saviour, it’s inevitably going to ruin relationships when either party realise love or determination is not enough to cure mental health issues. Believing that love can cure everything emotional, hurts people, it makes them feel ashamed when they are not strong enough to carry the burden of an ill partner alone, it makes women with post-natal depression feel sick with themselves for not feeling what they thought they would, and all of these feelings get buried as there’s still a stigma around being honest about mental health illnesses. How many people have found out about a loved one’s condition very late?! I highly doubt the ill person made a firm decision not to tell you because they didn’t need or trust you; it is usually from a place of wanting to protect you from something they feel ashamed of.
Ok, if you are in a relationship with someone who cannot perform simple tasks without your assistance because their anxiety gets out of control, you should want to find ways to help them control that anxiety so they are happier in themselves independently of you. It should not be taken as a sign of how much you meant to them or that you are the one making them better. Someone else’s illness should not make you feel of use or value; you are already those things and will still be when they are well. I have genuinely heard good people say, “I like being the one she needs, she doesn’t need a doctor if she’s got me” and it makes me feel very uncomfortable.
When my anxiety was at its worst I could just not make decisions, (which is common for people with anxiety) so basic things like food shopping would become a nightmare. Shelves in Tesco have never been so alarming as when you can’t quite decide which meat size is adequate, sauce is the taste you want, or remember which vegetables are needed, simply because all the choices are making your breathing strain and all you can think about is how much you just need to move out of that aisle and get yourself to pick the meat up but you just stand there feel paralysed, worthless and very much alone in a sea of ‘normal’ people who are just blithely picking up shit and dropping it in their baskets! Now, before I accepted my illness, my go-to solution was calling the person I trusted most, was asking for their advice (because I couldn’t hear/trust my own), and sending a flurry of messages, getting someone else to make the call. Sometimes I would just go home empty handed and lie, say I hadn’t gone, just to avoid confronting how useless I was.
So, what could have helped? Well, in my mind at the time, nothing! OR, when I was particularly irrational, not having an absurd expectation that I should have to do anything, or YOU DO IT, IF YOU LOVE ME YOU WOULD DO IT! If someone you love is projecting this sort of ferocity about food shopping, paying bills, anything that requires a time frame or decision and they seem totally unable to articulate a reason for feeling so awful about it, they might be suffering with anxiety. They are not just a lazy useless shit bag! (This is probably what they think of themselves at least 25 times a day) If you want to help them retain their independence, help! Facilitate them still doing things themselves, but take out the decision part that can feel so stressful, make a list of exact things (maybe even how many potatoes), do the shopping with them, but give them half the list, set up an online shopping account but make sure you work out how to use it together so it doesn’t trigger a feeling of worthlessness later. Sounds simple?
It isn’t… because all of this requires thought and patience and is probably completely at odds with how the person you are helping has lived before, so it feels patronising and weird. But, if your partner had surgery and you had to wipe their arse, you would, without hesitation, even if it was uncomfortable for everyone involved, simply because it’s necessary. Same with someone suffering with anxiety… Go through it with them, make life easier, without letting them stop doing things! Don’t expect equal levels of gratitude either, sometimes you will be the hero sometimes the enemy, nobody wants to be the person needing to be spoon fed. Nobody wants to be grateful about shared shopping, especially if you used to actually be fiercely independent or you are fearful about how this change might strain your relationship.
- Accept the whole, “it isn’t you, it’s me”
Bi-Polar, Depression, Mood Disorders, Anxiety, Post-Natal Depression… Often people who suffer with these things become inconsistent friends. Friends that seem to have faded to the background, stopped answering calls, responding to texts, cancelling things with you and generally, acting like a selfish arsehole. Welcome to the worst symptom and side-effect of illnesses that simply have you lying in bed for hours and lacking motivation. My mum once said to me, “have you ever thought that maybe people want to know you’re interested in them, that it doesn’t have to be you talking, that you could just listen and act like you’re still interested?” and I still can’t explain why this doesn’t feel like an option. All the time I was at my worst I still loved people, I just didn’t feel connected to them at all and that felt so terrifying that I didn’t feel capable of facing it. Yes, I actively ignored calls, made excuses for attending things and cancelled plans, but it wasn’t because I didn’t care, thought these old friends were worthless, wasn’t interested. I just lacked any motivation some days, others I felt consumed by panic and couldn’t convince myself to even reply to a message. A lot of people who are in the worst stages of these illnesses lose whole hours of their lives and can’t tell you what they were doing. I could have my phone in my hand for an hour and not type a text because I couldn’t find the words.
Especially if your friend has a diagnosis, help by accepting it’s them not you. Don’t stop inviting them to things, don’t play the old, “they can message me first” game to find out who cares more, don’t think they don’t need you either, these illnesses already make them feel isolated and worthless, try not to add to it. When you’re getting frustrated, tell them but don’t give up. Also, my best advice, find some new common ground, maybe they can’t face things that used to bring them joy, that’s not a reflection of you that’s a reflection of what they are dealing with. Dancing, late nights, big groups of people might be too much, you turning up with ingredients for a pancake breakfast, making the pancake breakfast and not caring they haven’t got dressed might be easier to face!
If you value this person, do your research too, the only friends I questioned when I was feeling more rational were the ones still angry with me for things that were clearly part of my illness not me, a simple google of anxiety will explain why huge chunks of my memory were off. If it was a type of Cancer you didn’t understand, you’d be on Google, it’s the same with mental health issues, you do not understand it just because you’re human and, “everyone has bad days”! Educating yourself will prevent a lot of bad feeling, when you see it’s the illness, not you or your friend.
- Don’t tell people meds are bad, you’re not a doctor!
This might be one of the more sinister things people with mental health problems experience, people telling them they don’t need meds, that meds are bad or that they will never be ok independently if they start using medication. Wow. If only those same people said, “getting shit faced won’t make it better, relying on alcohol to chat up a girl/dance/relax means you’re a slave to booze, I don’t think you are ever going to be independent again”. I’m not even going to bite my tongue on this, telling an ill person who might be finally starting to accept they need help that, “everyone seems to be on anti-depressants these days” is not ok. Let’s go back to Cancer, ever heard, “everyone seems to just get given chemo these days”? No, because there’s an assumption people deserve a chance to fight cancer with chemo, the same assumption should be made for someone with depression.
A little lesson for anyone terrified of these pills too, (bearing in mind I was, I left 3 different doctors’ appointments having a panic attack because they said I wouldn’t be able to control my anxiety without them and start to get better. Three times I rejected them and left unable to breathe, walk properly or hold myself up without assistance. That’s the amount of shame I felt for not being able to value my own health, luck, friends, family and life enough to feel happy or safe within my own skin.) The pills don’t take it all away, nor do they make you lose your ‘true identity’ (my biggest fear) if you are a hot-headed, judgemental little madam you will still be a hot-headed, judgemental little madam using the pills, you just might be able to understand what you’re hot-headed about and be confident about your anger rather than so consumed by it you can’t even breathe. You might get some sense of proportion and scale back, you might be able to understand that not being able to find a matching pair of socks and having a tooth pulled out are not equally as terrible.
The pills are not like a switch that will turn it all off, that is why people are often on them for a long time, the pills are just a step, they move feelings that threaten to drown you further away, so it’s easier to function, they don’t remove them, you still need to learn to challenge them and eventually force them out and that’s an even bigger battle, but the pills often help you have a little more energy for that main battle.
- Be open-minded: Therapy is good!
I actually added the section about pills and therapy last, even now, when having neither; I find these topics make me squirm a bit. I still have a sense that one day, probably when I try to adopt or get a job that requires a background check, my health record will be sneered at and I will be stamped as lesser. Maybe it’s silly, but I feel it nonetheless. But, why write something and hide from the bits you feel most passionately about? So, here goes. I have had 8 sessions of CBT, 38 counselling sessions, 12 physiotherapy sessions, 3 rounds of hypnotism (I don’t advise this, it’s not medically advised thing either, I was just feeling pretty desperate) 8 rounds of acupuncture and used anti-depressants for 574 days (frequently lying and saying I had stopped earlier to avoid people thinking I hadn’t worked hard enough to get off them) I also took up roller derby and spent 6 hours a week skating to try to get rid of some of the nervous energy I had and keep my mind in the moment, changed to working part-time so I could sleep more, attempted meditation and failed because of panic attacks, attempted mindfulness and failed because it made me feel worthless that I couldn’t focus on it enough.
I estimate I spent around, £1000 on my mental health, for the pills, counselling (£15 a session, I was lucky to get it at that rate, they offered a staggered donation thing based on earnings), acupuncture (for unexplained pains in my neck, head shoulders and sleeplessness) and hypnotherapy (that was £50 for 3 sessions, I was trying to find a way to get around the anxiety I feel about food textures). Without the NHS support in subsidising most of the pill fee, free CBT, free physiotherapy and free assessment of my health I wouldn’t have been able to afford to get well. I owe the NHS my sanity. The money, although I frequently resented paying it out, was the best investment I’ve ever made.
However, I was lucky, I could afford it. A lot of people cannot afford it or do not want to have to pay for it, maybe it’s a British thing? Our healthcare is normally free so if we need to pay for counselling maybe it’s not a good treatment? Whatever the reason, try to shake it. It’s been proven that the pills are more effective with the support of a talking therapy of some sort. I was only given free CBT because I was assessed as being severely depressed and severely anxious, if I had been diagnosed with mild depression or anxiety my CBT would have been online in an IT room in a weird youth centre, with someone sat at a desk checking us in and out, it would not have been as useful and I wouldn’t have committed to it. A computer is no match for a professional and there are professionals looking for work.
I think it’s important we all start demanding better provisions for those with mental health illnesses, sometimes I feel like this group are so under represented exactly because the government can avoid funding these services, so save money, as less people are willing to complain about it and argue entitlement as there’s a culture of blaming yourself for being ill that doesn’t exist with physical illnesses. That’s not ok. Vulnerable people need access to healthcare services, imagine if we treated the elderly with Dementia the same way.
Who am I to advocate sitting in a room and talking to a stranger? Just someone who benefitted from it. I am like many other people who get ill and take a long time to come to terms with it: I am lucky, privileged actually, I am well educated, come from a stable home and have always been put first by my parents, I have a strong group of friends, I have achieved a lot, travelled a lot, have good earning potential, good health and have always been loved. I still got ill. Depression, Anxiety and the whole gang of other alien brain invaders do not discriminate, much like death, they are equal opportunity employers. Frankly, other people do discriminate though, I don’t fit a bracket of people who should be ill, so often I was misread as being aggressive, moody and a general pain in the arse (which I was when I couldn’t get a handle of my moods because I couldn’t rationalise anything) a trained professional removes the expectation that you should get better right away because there’s people worse off than you, my counsellor and CBT practitioner helped me accept my illness when others wanted to deny it based on misinformed views of what these illnesses look like and the type of people who suffer with them.
A stranger does not have the emotional investment in you that a loved one does, you can tell a stranger that you don’t find pleasure in anything, that you don’t see any sort of future, that you don’t feel of any value or that you’re suicidal and not hurt them, not ruin their day, not damage your relationship irreparably. That same stranger is a professional that will not just say, “everyone gets down” or tell you, “you’ll feel better in the morning” they will calmly tell you it’s going to be a long journey and they step by step they will show you methods of coping on that journey, because the are professionally trained to do so, and they will see if you meet your milestones and recommend other things if you don’t.
Don’t be afraid that a therapist is taking your place, or filling someone’s head with the fact you are to blame. Allow someone you love to need someone that isn’t you, it will help you both.
- Be prepared to go outside of your comfort zone
People say stuff they mean in the moment but isn’t actually indicative of who they are at all. In bad spells, it’s hard to rationalise, bad stuff comes out. Try to work out what is simply said in a moment and what is actually lingering there that needs to be dealt with and challenge people, gently. Ask them to give you specific examples and if their examples could have a different interpretation offer it. But, be careful; offer it with kindness, good humour and in private. Challenging thoughts with evidence is one of the first major CBT goals, but it is very very difficult to accomplish it when you’ve had years of automatically responding and trusting your judgements. But letting people think stuff you know just doesn’t seem rational, isn’t going to help your friend, even if it does make the moment more comfortable.
Even if you’re a partner or parent to someone with an illness like Anxiety, and you know them intimately and they adore you, whatever you assumed was a fixed part of them and could always be relied upon to hold true, might change while they are ill. Adapt your expectations to help both of you. If your partner cannot get out of bed for work but you leave first, make it your responsibility to get them up even though it seems childish, make a cup of tea, pick out an outfit there and then, don’t just assume they will eventually do it without your help, it’s not always in them to fight the battle of a million decisions. It doesn’t matter that your partner used to tease you about how much you hate the alarm, or used to be a morning person, or is now only ever a little late, you need to face the truth about how some trivial things are now a trigger for anxiety and face them together rather than ignore them.
- Accept the apology
I’m not going to dwell on this one. Sometimes you will lose people to these illnesses, they will see you differently even if you haven’t changed, they will need different things from you without warning, they might not be able to articulate themselves and you might disappoint each other. Sometimes the damage lasts. Sometimes ill people only see things more clearly when they are well, at that point maybe they have cancelled on you one too many times or missed too many significant things, said unkind, cruel and regretful thing or just not been there for you. Maybe you can’t repair that, but at least accept the apology when they manage to see how they pushed you away. It wasn’t them, it was their illness and living with things you lost when you were ill is one of the hardest things to bear.
This is the longest post I’ve ever written and it’s pretty clumsy and could be prettier or funnier, but I guess I still don’t feel like this is a pretty or funny topic. A lot of people who need help are not getting it, those getting help are not actually getting as much as they should because of under funding, until people are screaming from the rooftops about mental health provisions like they do for provisions for Cancer sufferers it’s no trivial topic.
End the stigma, open up more honest dialogues. Let’s get better.