Last week Oaklan and I went on an adventure to London for the launch of the latest version of Mind’s flagship booklet ‘Understanding mental health problems’.
I wrote this when I was pregnant and it was great to see it finally published. It’s the first title to be published in the new full colour format – complete with pictures. It looks great and I’m really proud of my involvement.
‘Understanding mental health problems’ is one of the titles that Mind publishes as a booklet. You can find it in local Minds as well as workplaces, charity shops, universities and GP surgeries. You can also read it here. You can see the other titles I have written for Mind here.
Is that a cake or a book? Either way I want to eat it please!
Oaklan enjoyed himself too. He got a free apple in Pret after stealing it from the box and charming the staff, visited our old house in Mile End, had a picnic in Victoria Park, played on the swings and in the sand, met a London baby, slept on a walk through the Olympic Park, mashed strawberries into Mind’s carpet, came with us to the pub for a quick drink, looked out of the window of the DLR at Canary Wharf and threw spaghetti about in my brother’s kitchen.
Oaklan came on the 5th October. He’s almost eleven weeks now and things are slowly starting to feel a little easier. I’m still pretty tired – and I’m writing this with him feeding on my lap – so please excuse any typos, half-formed ideas or clumsy phrasing.
I wanted to get down some thoughts about early parenthood and mental health. It’s something I was pretty worried about. I was concerned about the lack of sleep and relentlessness of it, plus not being able to exercise enough and dealing with a very different shaped body.
I was on 50mg of Sertraline throughout my pregnancy (a decision that was definitely the right one for me) and I chose to increase this to 75mg in the first difficult weeks. I think that’s helped. But, despite everything, early parenthood has also highlighted some healthier thinking patterns and approaches.
The achievement of labour and birth
I’d hoped that pregnancy would change my muddled relationship with my body. I’ve heard women say that it helps them see their bodies in a new light and recover from long-term eating problems. This didn’t happen for me. The whole nine months was an uncomfortable struggle with my changing body. I felt trapped and out of control. By 41 weeks I was desperate not to be pregnant. But labour and birth were more empowering. After seven hours of contractions, he came so fast I delivered him myself at home. An hour ago the midwife on the phone had told us I was still in early labour. We were lucky but it’s still an experience I’m proud of. I finally managed to see my body as something special and cut it a bit of slack (at least for the first six weeks or so). Continue reading →
The awards aim to ‘encourage excellence in the production and dissemination of accessible, well-designed and clinically balanced patient information’. They look for accessible information that is evidence-based and well researched. It’s also important that people with lived experience are involved in the production of the information. You can see all the award winners here.
Information for young people (for the Miscarriage Association)
The youth resources I researched and wrote for the Miscarriage Association were highly commended. They were also given a runner-up award in the special category for Young Adults. I was particularly pleased with this award as I managed the whole project, conducted the on and offline research with young people, developed recommendations and wrote the resources themselves. You can read more about the consultation process here.
It was reviewed by Dr. Hannah R Bridges of HB Health Comms Ltd who wrote:
‘Wow! This is a wonderful example how good consultation and understanding your audience can lead to great quality information! The Miscarriage Association has identified a need for materials to support young people, who have different experiences and support needs. The consultation, planning, and promotional plans show excellence in producing health information. This shows through in the end products – high quality and extremely well-tailored to the audience. The insight and thought that has gone into this is commendable. Take for example the ‘what happens when you call our helpline’ page – simple, highly visual, concise and reassuring information to encourage young people in need of support to dare to pick up the phone – the overall impression is one of kindness. Just wonderful.’
Money and mental health (for Mind)
The information product Money and mental health I wrote for Mind was highly commended. It also received a runner-up award in the special category for Self-Care resources. This resource was one of the first to be written in a new ‘hub’ format. It involved research with Mind’s online community and social media audiences, working with bloggers with lived experience and researching common problems and support options.
Unfortunately, I couldn’t attend the awards with colleagues from either charity – at 39 weeks pregnant it wasn’t worth the risk of going into labour on the train from Bristol, at the awards or in my brother’s shared house. But it’s a lovely way to leave work for a while.
Last year, James Withney of The Recovery Letters emailed to see if I would be interested in contributing a letter to the published anthology. The Recovery Letters are addressed to people experiencing depression. They share experiences and give friendship and hope for recovery.
I’ve tried to emphasise that you can find eating problems incredibly difficult to live with, without necessarily having a diagnosed eating disorder. I also wanted to make sure it was clear that you can have an eating problem or disorder without being noticeably over or underweight – and that you shouldn’t need a certain BMI or a particular diagnosis to access treatment. It was important to make sure the information was accessible and useful to everyone – including men and older women. These are both groups who are affected by eating problems but often less able to speak about their experiences and access treatment. I also tried to include blogs and quotes from lots of different people, about a range of experiences and problems.
It wanted to talk about the fact that even thinking about recovery can be scary. Eating problems can feel safe – and even exhilarating. Despite an eating problem making your life difficult, you may not feel ready to try and recover straight away. On top of this, I wanted to expand the information we provide on coping with recovery – dealing with food and eating every day in an on and offline world that can seem to spin around eating, food, weight, appearance and body image (you can read more about my own experience here). Sometimes you can look healthier physically, while mentally you’re actually feeling a lot worse. Recovery can take a long time and relapse is common.
The Information Standard
All Mind products are written to the Information Standard. This means that a first draft was reviewed by a number of people with personal and professional experience of eating problems. I love this stage of the writing process as it always gives you new things to think about, and opens my eyes areas I may not have considered or covered properly. We also make sure we consider and respond to all the feedback we receive – I’m looking forward to reading this too (whether it’s positive, negative or suggestions for improvement).
I’m pretty good at managing my mental health. I know what helps, what doesn’t and how to recognise when I need to take better care of myself or ask for extra support.
But early pregnancy disrupted this balance. I’m nearly 17 weeks now and finally ready to write about the first trimester.
Awareness of perinatal mental health is increasing. Most people know about postnatal depression but I’ve seen more conversations about antenatal depression, perinatal anxiety and postpartum psychosis too. I’ve heard less about how to prepare for the way dramatic physical and psychological changes can interact with existing problems.
Taking antidepressants, managing eating problems and dealing with depression and anxiety
It turns out I’ve got a lot to say so I have separated them into three blogs.
I’m 17 weeks pregnant and still taking the SSRI antidepressant Sertraline. I thought I was pretty firm in that decision. An attempt to stop taking it last year ended badly. But we had to try, if only to help us work out where we sat in the endless risk/benefit balancing act.
But I was still thrown when my GP (a new doctor who didn’t support me through withdrawal, relapse and re-prescription) told me I should try to come off – “You could just stop immediately on that amount – or you could take it every other day for a couple of weeks and then stop”.
She seemed convinced the main reason I found it hard to come off them last time was because I was anxious about trying to conceive. In the time we had it was hard to explain that it was considerably more complicated than that.
Mental health agendas vs. pregnancy agendas
When you are pregnant and also manage mental health problems you have lots of people telling you what to do. Different authorities often have slightly different agendas, follow different recommendations and suggest different things. It feels like an extra layer of disempowerment and it’s hard not to get caught between what’s best for your mental health and what’s recommended in pregnancy.
a well considered and discussed (with a doctor and my husband) decision to start taking them again
an awareness of the power imbalance implicit in a doctor’s consulting room
access to – and knowledge of – a lot of relevant research that emphasises the importance of maternal mental health and the danger for both mother and developing baby of coming off when it isn’t appropriate
an awareness that the ‘risk’ referred to here is pretty small and that everything has risks and benefits – I shouldn’t take the fact that something has a risk associated with it as an automatic reason not to do it
an awareness that doctors are told to advise women to stop as there is very little safety info but this is a precaution and for some women, it can be better for them and their baby to remain on medication
Questioning my decision
But despite ALL this, I still walked away from the doctor feeling pretty wobbly and thinking “maybe I should, the doctor is telling me I should after all”.
It took another discussion with Alex and some more reading and research to help me feel confident in my decision again. Continue reading →
Over the last year, I’ve been facing up to eating problems that have dogged me my entire life. This became particularly important as we tried (and for a long time failed) to conceive. It was really hard going but I got my cycle back and my hormones balanced – by the time we conceived my levels were fine. I gained weight until my BMI settled in the mid/high normal range that seems to be where my body naturally wants to hang out. I preferred being smaller but I was (slowly) teaching myself to feel positive about the changes.
This is what recovery looks like for me. After 24 years with these thoughts and feelings, I’ve pretty much accepted that I’m never going to be completely free of them. But I’ve learned to manage them in a healthier way, enjoy exercise and let myself eat without feeling too guilty (usually).
A naive hope for eating problems and pregnancy
I had nurtured this (naïve) hope that during pregnancy my muddled relationship with weight and eating would somehow vanish. Or at least become a lot easier as I nurtured my amazing baby growing body, forgiving weight gain and enjoying my new curves. HA. Load of bollocks.
I had some very low periods and dark thoughts during the first trimester of pregnancy. The myth of pregnancy as a calm, exciting and enjoyable time is still pervasive – but there were times when I felt unable to take pleasure in anything, distant from Al and scared I wouldn’t be able to feel anything for the baby either.
Nausea and exhaustion were draining and left me more vulnerable.
I couldn’t do almost anything I used to enjoy or that helped me manage my mental health – challenging myself with long runs, tiring myself out with speedy bike rides in the hills, skiing with friends, winning races, revelling in that gorgeous post-exercise feeling – even drinking tea and having a long steaming hot bath.
Nowhere felt like home – my supercharged sense of smell means that the smell of the house made me sick. It’s exhausting to have nowhere comforting to retreat to.
All of these are manageable individually but they made a toxic mix when combined with existing mental health problems.
One big anxious thought
I have a diagnosis of clinical depression and anxiety – but it’s tended to be anxiety I’ve struggled with over the last couple of years. Anxiety get’s its claws into whatever is going on and warps it out of all proportion. In the first trimester, there is a LOT for it to hook onto. Al always tells me to try not to think ‘big thoughts’ when I’m anxious but for a lot of those first 14 weeks or so I just felt like one big anxious thought.
I’m feeling a lot better now. I have a referral to the obstetrician who specialises in mental health – but my appointment isn’t until June. In the meantime, I spoke to an amazing midwife who really seemed to understand and agreed that 27 weeks was very late for starting any additional perinatal mental health support. She referred me to see a psychologist a little earlier. I’m not sure how (or if) these appointments will help but I’m keeping an open mind and making sure I have as much support in place as possible in case things get harder again.
Mental health problems have a way of taking over. I’m lucky enough never to have been hospitalised or signed off work. Life has always stumbled on. But moods and behaviours creep in and twist their tendrils around daily life. They trick you into thinking they’re normal, into nourishing them. It’s not until they start to suffocate and strangle even the simplest of things that you recognise their power. And then it’s too late for an easy fix.
This year I’ve started the long process of hacking away at the thicket and pulling up roots that go incredibly deep. It hasn’t been easy. But now I’ve made some space it’s much easier to see what a tangle I was in.
Eating new food
I recently turned 33 and enjoyed a breakfast made for me by Alex without having to purge it through exercise.The day before my birthday last year I was panicking over choosing something nice (and therefore different) for my birthday breakfast. I cried outside the bread shop. I ended up with toast and even then it was a tricky day.
Letting go of control in the kitchen
I no longer have to have control in the kitchen. I’ll eat something made for me by someone else – even if I didn’t see whether they used butter or check how much oil they added.
Reaquainting myself with cheese
I had cheese on toast for the first time in two years last week (cheese has been a scary food for years). Continue reading →