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.
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.
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.
I had cheese on toast for the first time in two years last week (cheese has been a scary food for years).
I’m selling some of my favourite clothes. Some of them are definitely too small. I bought them when I was at my lowest weight last year. Fitting into a smaller size was an unhealthy but irresistible boost to a fragile self esteem that had narrowed to focus only on my weight and ability to exercise to exhaustion. They hang in my wardrobe now and remind me, daring me to go back there. It would only take some long runs and a few weeks of restriction. They are better off living with someone who is naturally a smaller size.
Some of them still just about fit. They’ve always been close fitting, that’s just their style. As a result they are often barely worn – rejected because my muddled mind translates their constant pressure on my skin as a sign of being too big.
But now I’m working to reduce my exercise without restricting my food. My body is softer and larger. Getting dressed is one of the most difficult times. Tight and restrictive clothes risk triggering an avalanche of recrimination, irritation and anger. Yesterday I threw a banana at the wall. It’s funny now but at the time I was so angry at my mind for telling me I had to choose fruit over toast until I had run (on a day when I wasn’t supposed to be running at all).
My favourite clothes are a tangible reminder of change that doesn’t always feel welcome. I’m trying to learn to like a softer, curvier frame but it’s hard. I’m scared of losing control. I’m fighting to stay away from unhealthy patterns of thought that started carving deep grooves in my mind when I went on my first diet aged 9. It will always be much more comfortable to let go and slide back into them than to resist and live day in and out in a body that feels heavy and uncomfortable.
It’s easier if I don’t risk it, if I say goodbye to those clothes and that time and look forward.
I can’t afford to buy a whole new wardrobe but I’ve bought a few larger sizes, baggier clothes. They help me forget the discomfort and move my focus to all the other brilliant things in my life – work, family and friends I love.
In the past the fact I KNEW they were a bigger size would ruin this comfort. That disordered inner voice would keep reminding me that wearing a larger size meant I’d failed. That I wasn’t in control. Ridiculously I would rather be uncomfortable and sad in clothes too tight than admit I am bigger and be happier in clothes that fit. But this time I’m determined to make real change – for my mind, for my body and for the hope of conceiving.
In her brilliant memoir of anorexia and bulimia The Time in Between, Nancy Tucker writes about a pair of shorts…
“One of the most painful things about this period is The Shorts. I have a pair of denim shorts whose label bears the glorious declaration ‘Age 6-7’ and they become one of The Voice’s favourite instruments of torture…. eventually it is a panting struggle to pull them on and when I take them off I have crusty sores on my skin where the denim has rubbed me raw. I don’t know whether it is because I need reassurance that my body is still acceptably small or because the pain of wearing them serves a hair shirt, self flagellation purpose, but from the time I hit my lowest weight to three, four, five months afterwards, The Voice insists I wear these shorts every day”.
Her anorexia was far far worse than any disordered eating I have experienced. But her words show the incredible power that the warped voice of eating disorders can give to clothes and clothes sizes. After 23 years of letting buttons, zips and waistbands rule my life, it’s time to start letting that go.
A few weeks ago had an internet date. Of sorts. Not a romantic first date (thank goodness) but a face-to-face meeting with someone I met online. Someone like me in lots of ways. Someone who could be a friend.
We knew a lot about each other’s vulnerabilities and fears before we set eyes on each other. And that made things much easier. The conversation could get right to the good stuff. We could be open and honest. We chatted about medication, work, diagnoses, panic attacks, weddings and how our dogs help with our mental health. Not really first date fodder.
It’s all down to our blogs. Claire writes WE’Re AlL mAd HeRe about social anxiety (she’s also been asked to write a book about anxiety based on her blog – wow). She got in touch a few months ago and suggested lunch. I’m so glad she did. Meeting inspiring new people is just one of the things that blogging has done for me.
I’ve had a number of readers get in touch with me recently about starting a mental health blog – overcoming those demons of uncertainty that whisper ‘what’s the point, who cares what I have to say?’
I know the feeling – I have it about writing fiction. But I thought I’d share a little about what blogging has done for me – and a few things that helped me get started.
Yesterday we celebrated our first wedding anniversary. Our wedding was a magical day but, in the two years since we got engaged, life has taken some unexpected turns.
My mental and physical health has taken quite a bashing. I’m not fully recovered – and I’m working hard to challenge and change thought patterns and reactions that have been deeply ingrained for many years. But I’m gaining more perspective with each month that takes me further from the trickiest of times.
So what would I tell the Clare who said ‘yes’ under that tree on Hampstead Heath in 2015.
I thought I would be able to diet just enough to feel comfortable in a gently corseted dress – and then stop afterwards. But my disordered eating lurked much closer below the surface than I realised. It wasn’t long before my eating, exercise and emotions got horribly tangled. I thought I would never go back there but I slid into militant calorie counting, restriction and purging through exercise with the excuse that it was ‘just for the wedding’. The dress was too big, I spent our honeymoon struggling to find a manageable balance and it took my periods stopping to shock me into making a change.
“You were so proud of yourself,” my mother in law said. And I was. I had been fighting my medication for years, trying to cut down and come off. Stopping was the hardest thing I’d ever done.
And when I finally fought through the initial withdrawal symptoms I thought things would get easier. Instead they got harder. More chest pain. More tears, panic and anger. Suicidal thoughts. More running. More fighting my body. It took three months to realise I couldn’t do it. That nothing was worth the destruction those months had wreaked on my body, our health and our relationship.
Mind has been asking people to #TakeOffTheTape and share something that makes them anxious. Something they haven’t spoken about before.
I thought I would use the opportunity to write about something that’s hardly spoken about at all.
I’m finding it incredibly hard to balance trying to conceive with managing my mental health.
We don’t talk about this. We don’t even talk about the first twelve weeks of pregnancy much (as I’m well aware from my work with the Miscarriage Association). Trying to conceive often happens in almost complete secrecy. I didn’t realise how it would interact with my fluctuating mental health and I wasn’t prepared.
It’s taken a while to get to this stage. The doctor who removed my coil last year strongly implied that it would be best to continue with my efforts to come off my Citalopram. She moved me to Sertraline (it’s considered safer in pregnancy) and told me to try and reduce my dose completely over the next month.
In fact it took me three more months. I’ve been trying to come off anti depressants for a while anyway (after a muddled fifteen year relationship with them) and trying to conceive gave me the strength to make it through a hideous withdrawal period. It was probably the hardest thing I have ever done. Alex didn’t have much fun either. I’ve written about it here.
I’m more vulnerable to hormonal changes now. I still have very dark times when everything seems hopeless and I can’t see a way through the next ten minutes let alone the rest of my life. Difficult images and ideas jostle with an endless repetition of fears and doubts. Sometimes the same phrase over and over again. They whisper just below the surface of my consciousness. They’re loud enough to wear me down and shrink my focus to a single point of constant worry – but not quite conscious enough for me to recognise what’s happening in a way that helps me stop.
One these days I’m separated from the world by thick glass that bounces every negative thought straight back at me, infinitely magnified. My attention is forced inwards but my mind is everywhere but present, infecting all it can with worst case scenarios. I can’t look up and out, can’t see the variety of the world and my place in it, can’t take a long deep breath. My chest physically hurts and I feel constantly sick with the fight or flight chemicals flooding my poisoned body as it tries to deal with the powerful threat of my mind.
These times are getting further apart and each one adds detail to our understanding of the best way to manage them. But trying to conceive has made my anxiety worse. It’s given it another peg to hang its hat on. Issues with eating and body image are often about control (with an emphasis on control over your body) – and anxiety hates uncertainty. But trying to conceive is a very uncertain time. What my body does – and doesn’t do – isn’t completely under my control.
I was managing my mental health to the extent I felt I was in a position to come off medication – in order to do something that has made the problem worse again. The irony isn’t lost on me – although on bad days it just makes me want to cry.
Every time I go to press ‘publish’ on a tricky post exploring my mental health I pause for a moment. The way my blog has developed means that my personal struggles and successes sit alongside blogs about my work and details of my skills, training and experience.
I know stigma and discrimination around mental health in the workplace exists. I spent 2014 providing evidence based reports on mental health policies and support in a number of organisations across a range of sectors for the Time To Change Organisational Healthcheck programme. Tom Oxley writes a good piece about how the programme worked on pages 10 and 11 of this newsletter.
I spoke to people in every workplace who said that they wouldn’t tell their manager if they were experiencing a mental health problem. Many said they would lie about taking time off.
”I’d probably say I had a migraine or something”
Those who had been honest about taking time off for a mental health problem said they felt that now they had more to prove.
Unfortunately in some cases I could understand why. Some managers said they felt people with mental health problems couldn’t ‘cope’. Others saw investment in employees’ mental and physical health as a burden rather than something that makes moral and business sense.
”You’ve got to be careful or people will just take advantage, start using ‘depression’ as an excuse.”
”We need people on top form to do this job – if you’re depressed you just won’t be able to cope.”
1 in 6 employees are currently dealing with a mental health problem. Like colds, flu, delayed trains, bereavement and accidents it’s always going to be part of a workforce. It’s how employers deal with it that counts.
My mental health is part of what makes me. It’s part of what makes a life – and in many cases it’s part of what makes me good at the work I do.
In the run up to Time To Change’s Time To Talk Day on Thursday I thought I’d share some of the reasons why I press publish on those tricky posts every time.
I’ve recently come off Sertraline after 15 years on various SSRIs. It’s been a long and tricky journey but I think I might be almost there. I’ve written a bit more about that here.
I love a metaphor when it comes to managing my day to day mental health. Metaphor helps me identify and pin down my experiences. This is a step towards understanding and managing them. It helps me regain perspective and use the language of shared experience to transfer and talk about some pretty intangible feelings.
I haven’t had much perspective recently. Feeling anxious seems to magnify individual moments. It’s as though I am living life too close up. I don’t have the capacity to see beyond the worry I’m experiencing right now.
My nose is right up against the canvas rubbing in all the tiny flaws and bumps. From here they look huge and distorted. But we all know an oil painting looks better from afar. The swirls of dark colour and the lumps of paint add texture and depth to the bigger picture.
I’m not saying that this kind of anxiety is necessary or important to make up the picture of a life – it really isn’t. BUT I have found that whispering ‘remember the oil painting’ to myself has reminded me to step back and question whether the worry that’s causing overpowering anxiety right now will matter at all in a year (or even a month or a week). It’s helped stop those tricky surges of panic become uncontrollable.
As I write I’m on the sixth day without any form of SSRI at all. This is new territory for me. I’ve taken them every day for 15 years (with terrible healthcare making it much trickier).
Three months ago I moved to Sertraline. Two months ago I was down to 1/4 of a tablet per day. Then I started alternating days. One month ago I moved to one day on and two days off. Over the Christmas break I’ve been attempting one day on and three days off. This time round when it got to day four off I decided to keep going.
It’s been a LONG time coming. I’ve been bobbing around the 20-30mg mark for years. I tried to come off them in 2008 but didn’t get below 10mg Citalopram before an abortion and a move to London meant I needed more support again. I tried in 2012 but again couldn’t drop below 10mg. In 2014 I got to 5mg before it became unbearable and ended up slowly and frustratingly working my way back up to 20mg.
My chest sometimes feels uncomfortably tight and I’m still welling up at the slightest thing but I haven’t had any big uncontrollable surges of irritability (horrible), anger (scary) and panic (painful) since before New Year. The worst day was the first time I got to three days without. That afternoon there was little to be done except pick my sobbing self up off the bathroom floor and breathe deeply in showers as hot as I could bear. I would lie completely still in bed hoping for sleep but fearing the threat of my mind building, rushing and slipping away into a place of panic and pain that felt unknown and terrifying. It’s really scary to feel genuinely out of control of your mind. Luckily there was only one afternoon that bad.
I only feel completely safe when I’m exercising and in the calm and blissful hours afterwards when I’m myself again. I’ve ran hundreds of miles. When my knee gave out I cycled hundreds more. I discovered spinning. I’ve been chaining Kalms and I haven’t had a good coffee or a glass of wine in weeks (interestingly when you’re recently married and of a certain age people tend not to push alcohol on you, even at Christmas!). But I’m nearly there. I really think I might be.
I’m very very lucky to have such supportive and loving friends, family, work and (most of all) my husband Alex. My family love me unconditionally even when I’m unforgivably difficult. My friends make me feel myself again just by being in their company. But Alex is endlessly patient. Those surges of anger and irritability disguise themselves as reactions to things happening day to day. They show their ugly faces in snippy comments, slamming doors and helpless tears. He recognises these as symptoms. He knows that deep down they’re not my fault. He doesn’t react to them as if they are. This is perhaps the most helpful but also the most difficult thing someone can do to support your mental health. He’s an absolute hero.
(I’ve also written about managing depression and anxiety in relationships here)
There’s been plenty of dramatic lows and a few proud highs in this particular journey. But a lot of the experience of living with and managing this stuff is the day to day mental grunt work. Looking after yourself. Recognising triggers and identifying negative thoughts. I’ve been doing a lot of that too.
I love a metaphor when it comes to managing my mental health. Metaphor helps me identify and pin down my experiences. This is a step towards understanding and managing them. It helps me regain perspective and use the language of shared experience to transfer and talk about some pretty intangible feelings.
Over the last few months I’ve found a couple of new ways of thinking about my experiences which really help day to day. The tapes and the oil painting. I’ve written about them here: The Regret Tape and the I’m Not Good Enough Mix – new metaphors and thinking tools for managing anxiety and depression.
I don’t know what’s going to happen next and I’m going to try not to beat myself up if it doesn’t go quite as planned. But I’m cautiously pleased and proud to have made it this far. The sun is shining and I’m off out with the dog (he helps a lot too). I might even treat myself to a (decaff) coffee.
It’s worth emphasising that I spent a long time reducing my Citalopram and then Sertraline slowly in 2015. I did the withdrawal and reduction with advice from my doctor. This is a personal account of an individual experience. Mind has a lot of great info on coming off psychiatric drugs which it’s worth looking at if it’s something you are thinking about.
“I’ll always remember the first time I met a ‘PP lady’. It was a very special day.”
“I had lots of friends who were mums but none of them understood what I was going through. I felt weird, lonely and isolated. When I found the forum I was like ‘Oh my god. People understand.”
Every year it is a moving and inspirational day (you can read about what we covered here). As I listened to the co-ordinators speak to new volunteers I was struck once again by just how important their peer support programme is.
In fact I think their services are a really good example of the life changing benefits that online peer support can provide. Peer support can be valuable for everyone but it is absolutely vital for APP.
Research by APP shows that women desperately want to meet other people who have been through PP, to share symptoms and have time to talk. Partners said the same.
Everyone needs to share stories, to be accepted and understood – especially if you’re going through or recovering from severe mental illness. Unfortunately, because PP is relatively rare, friends and family don’t know what is is or what it feels like. There is unlikely to be someone living near you who has been there. Some people may be scared to speak about their experience for fear of stigma and misunderstanding. For most women the APP Peer Supporter training sessions are the first time they have been in the same room as someone who has also experienced PP.
APP’s forums provide that link. They connect people with hundreds of others who can support them. When someone signs up for APP’s one-to-one email support service they are actively matched with someone who has had a similar experience. The chances of finding that offline are very very small.