I’ve been thinking for a while that I might finally be getting better. I’ve had both low and high intensity cognitive behavioural therapy in the last 6-12 months, which I really learned a lot about myself from, and which enabled me to control my anxiety a bit better. I also have been pacing myself a lot more with my work, and managed to solve some of the issues that had been bothering me on a day-to-day basis, such as finding a new job to replace my old, stressful one. I managed to up my meds with no significant side effects. I have been exercising just like they tell you to do when you’re depressed. I make myself go out and be around people when the last thing I want to do is be sociable. Actually, I’ve been doing just about everything ‘they’ (doctors, psychologists, mental health professionals) say you should be doing to keep yourself happy. And so, I told myself that I must be getting better, because how could I not be when I’ve exhausted all my options? What else is there left to do if I don’t get better from all that?
But, as you may already suspect from my tone in that last paragraph, I am coming round to the idea now that I might not be as okay as I thought I was. I’ve been trying to fight against that thought for months, because honestly, the idea that I might still need more help, or that I still have some ‘getting better’ to do terrifies me! I feel like I’ve run out of solutions treatment-wise. I go back to my doctor for help, but she just tells me that I need to stop over-thinking things, or that sometimes it’s normal to feel certain ways. Maybe I brought that response on myself however… After all, I did admit that I was concerned that I might be making myself feel depressed, and stopping myself from getting better.
I’ve been seeking treatment for my depression/mental health problems for coming up to 7 years now, give or take a few months. So really, that makes it a chronic condition rather than an acute one. And I think when it comes to mental health problems, whether an illness is chronic or acute makes a world of difference, particularly to the way that the patient perceives themselves and their illness, and how accurately they are able to identify changes in behaviour away from what is ‘normal’.
When someone first experiences a ‘depressive episode’, having not ever been clinically depressed before, the changes in their behaviour will be fairly stark and plain to see. Someone might go from being a social butterfly to wanting nothing more than to stay inside the house all day, away from the pressures of being sociable and having to interact with people. Their appetite may either increase or decrease, they may experience sudden weight loss/gain, or they might suddenly find that they either sleep all the time or find it incredibly difficult to sleep at all. It wouldn’t be true to say that everyone can identify a definite change in their personality/behaviour upon encountering a depressive episode, but certainly I think that for the large majority of people, they will be able to complete a questionnaire and provide evidence for a substantial change indicative of depression. For me, I don’t feel like this is the case at all. Maybe to start with I experienced depression in ‘episodes’, where I saw a noticeable change in my motivation, concentration and mood etc. But honesty, nowadays I just feel like I’m consistently not experiencing life like I should be. But it’s been such a long time since before I first encountered depression, I can’t remember what that felt like. Which leads me to wonder: Am I better already, but I’m so used to being depressed that I drag myself back down out of the desire for something familiar? Or am I genuinely still ill? Is my knowledge of psychology hindering my recovery, as I constantly analyse and over-think my cognitions and behaviour?
I suppose the only way to find out is to look at the evidence as objectively as possible, considering these are my own subjective emotions that we’re discussing! Like I mentioned just now, when depression is acute, the difference in mood or behaviour before and after is very severe. You can easily compare the two and know that the low mood you are experiencing is not normal, because your emotions before were so much more positive. However, after 7 years, I sometimes doubt myself. When I’m sitting on the sofa, and I’m trying to motivate myself to get up and do something (such as work on my dissertation or make a phone call), I agonise over whether I can attribute this to my depression, which is known to sap energy and motivation, or if I’m actually just being lazy. How do I tell the difference anymore? When I’m in a class and I’m struggling to concentrate and take in the information that’s being given, is this due to my mental illness too? Experiencing poor concentration is another well-documented symptom of depression (and anxiety, which I have also been dealing with), but maybe I’m just not trying hard enough? I could go on and on like this for all my symptoms… But thinking like this is pretty exhausting, and at the end of it I just want to cry while I wait for someone to come along and just make everything better for me.
To be honest, I’m not sure what I’m getting at here. Really, I think that I must still be unwell. Because the thought that everything might just be my own doing, and that I just need to suck it up and get myself together is devastating. And that can’t be normal. If it’s normal, then I really, really don’t want to be normal at all! I can’t live like that, always doubting myself and trying to deal with the pressure of succeeding and functioning. But equally, the prospect of having to fight my GP for more referrals for therapy is so daunting. I just don’t have the energy to do that. I also don’t particularly want to increase the dose of my medication again. The more drugs I take, the higher the risk of side effects is, and the harder it will be to come off of them eventually. I also have a fear of sinking into apathy, where the only way to get away from my anxiety and depression is to take so many drugs that I feel nothing at all.
I’m so angry that it’s this hard to get help from the NHS for a mental illness. So I haven’t been able to get better from the treatment that they initially provided for me. I also feel like I’m being told that I’m not ill enough to qualify for any more support. So am I being punished for being too ill but also not ill enough at the same time? It’s a worrying thought for me, because I’m certainly not getting better by myself, so the only way to go is down. How sick do I need to be before someone will help? And how can I objectively prove that I am at that point? I can totally see how people with less support from friends and family than I have feel like their options are limited. Desperation can lead people to do very extreme things. All I can say is that I am so, so thankful for my family and friends, and for my extended social circle who I interact with regularly. You guys are my lifeline.
In an ideal world, what I would like is for my GP to refer me to see a mental health professional, who can re-assess my symptoms and make recommendations as to what treatment I should be seeking. I want to know for sure that I have spoken to someone at length about my history of mental illness, and about my current thoughts, feelings and behaviours. I want to be given a correct diagnosis, or at least a more accurate summary of what my difficulties are and where they stem from (the debate about the usefulness of a diagnosis is a totally different ball game), and then what drug treatment and/or talking therapy I might find most useful. People change over 7 years, and I’m no different. I’ve gone from mild depression, to moderate depression, to self-harm and an overdose, to mild depression, to anxiety, and then to anxiety with depression! My mental health, just like my physical health, is in a constant state of flux. I want the care I receive to reflect that.