Getting “better”

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.

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It has to begin somewhere!

Trigger warning: Self-harm, depression, anxiety.

 

Hello. My name is Jess, and I have a mental illness.

 

Obviously there’s more to me than my diagnosis- anxiety and depression, by the way- but sometimes I feel like it’s so all-encompassing, and that it totally dictates my life. This is why I want to start a blog and share my story with you. I feel like it might help me to reclaim the parts of me that should be defining me, like my values and my goals, rather than letting my mental illness take that all away from me. Part of my problem is that I will ruminate over things for hours and days and weeks, but I want to use this blog as a way to externalise my musings and experiences. I hope that as well as being therapeutic for me, this blog can also teach other people about what it’s like to live with a mental illness, and even also help other people in a similar situation to not feel so alone. I want to start by telling you about my journey in general, and then I hope to be able to discuss some of my thoughts and feelings in future posts with more depth to them.

The first time I can remember being depressed is back when I was in Secondary School. I must have been 14, give or take a year? It just kind of crept in, like when it starts getting dark in the evening, and at first, you don’t really notice it, but then all of a sudden it is pitch black. Something I’ve discussed with mental health professionals and therapists over the years is what I think triggered it, but the simple answer is I can’t really be sure. I’m told it can just happen for no reason at all, but this isn’t very common at all. The favoured theory is that when my relationship with my biological father broke down, I internalised a lot of guilt and responsibility about it and that this was then expressed through depressive symptoms. When I was younger, I very much disliked this theory, and was adamant that I had done the right thing and wasn’t missing him at all, and to an extent this is true. I don’t really feel any attachment to my biological Dad. I certainly didn’t miss out on having a father figure in my life, as my Stepdad was so supportive and loving that I actually feel uncomfortable calling him my ‘stepdad’, as I don’t think of him in that way. So let’s just call him my Dad. But I suppose that I’ve always been quite aware of the way my actions impact upon others, and I was made very aware on several occasions that my biological father and his family thought I was making a mistake, and was being unduly harsh. Being that I was very young at the time, I suppose they initially chose to blame my Mum, but now that I’m an adult and still haven’t reconnected I’m sure there can be no doubt in their minds as to who is responsible for the lack of contact.

In any case, I can certainly see how the guilt and uncertainty during this time would have made me very upset. But what I can’t explain is why this nestled in my mind and has remained there ever since. What’s more, it’s not even the same illness that it used to be. I think this is something that people often don’t realise about mental illness- It’s not a fixed condition, and as the individual grows and learns and develops, so the condition will change with them. Think of it as something very fluid, rather than being a concrete illness. I very much fit the ‘Depression’ symptomology when I was in school. I cried a lot for no reason, I felt angry and upset and this was intensified by me bottling it up after being told I was just hormonal. I discovered the practice of self-harm when a friend started doing it, and after that I dabbled with cutting and scratching and hair pulling as a way to manage my emotions. By this time, I was seeing a school counsellor, but this was a very transient thing and I didn’t ‘click’ very well with the therapist, so it was largely ineffective. I suffered from “mild depressive episodes” for a while (this is how the doctors refer to it on paper), but after a few turbulent experiences, all very standard occurrences for teenagers, my depression intensified and I went to a doctor, begging for help.

I was referred to the Children and Adolescents Mental Health Service (CAMHS), where I was prescribed fluoxetine- more commonly known as Prozac- and a course of Cognitive Behavioural Therapy (CBT). My CBT counsellor was a lovely woman, and definitely helped me gain some insight into my condition, which did wonders for me in the long run. However, the medication didn’t agree with me at all. You may be aware of the fact that some antidepressants are dangerous for under 25s to take (I was 17 at the time), as for some reason or another, they can induce thoughts of self-harm and suicide. I can’t remember whether my self-harm increased, but one morning before school I took an overdose of antihistamines. The overdose itself obviously had its own side-effects, such as dizziness and blurred vision, and hallucinations, but it unfortunately also interacted with my fluoxetine. I for some reason didn’t believe the drug would have any effect, and went into school as usual. By the time I arrived in my common room, I could barely walk and was finding it difficult to focus on anything or speak properly. Thankfully, I then panicked in a massive way and told a friend what I had done, and was taken to hospital. No lasting effects, except for an overwhelming sense of guilt when I think about what I put my loved ones through. I’m eternally grateful to them all for supporting me through it though, and for being so wonderfully understanding.

So that was medication out for me. I completed my course of CBT and began to feel better. I turned 18, completed my a-levels, and went to university. I met my boyfriend in the summer before I went to uni and actually ended up going to the one he attended due to me missing out on the grades I needed for my first choice. I wouldn’t change a thing though! Everything was going brilliantly. But then the depression crept back in again, and by the time my first semester at uni had come to a close I was very much struggling with those same symptoms as the ones that I had when I was in school. I cried a lot, and I started self-harming again. I was panicky from time to time with no apparent trigger, and I felt like life had no meaning, and held little enjoyment for me. Eventually, I was put on another antidepressant under the condition that I would keep a very close eye on my thoughts and mood. This worked for a while… Like, maybe a couple of years. And then I got a bit worse again, and went back to see a GP again, and switched my medication, and was put in touch with LIFT, a local NHS provision which aims to provide psychological therapies to people with a mental illness.

By this time, I had developed the anxiety part of my diagnosis too. I think that, in an effort to get away from my melancholy, I filled my life with responsibilities and activities to make sure I wouldn’t get caught with nothing to do but think about my feelings. First I took on a part-time job, then another, then another… I started volunteering too, and decided to embark on a massive fundraising challenge. So I ended up in a very different but equally destructive cycle where I was busy 90% of the time, working or attending uni or exercising while still trying to maintain my relationship with my boyfriend and make time for my friends and family. It was exhausting, and burned myself out on more than one occasion, ending up bedridden for a few days at a time while my body tried to make repairs and refuel. I started worrying all the time about the things I had to do, and the physical symptoms of anxiety, such as stomach cramps and nausea, made themselves known too. I felt on edge all the time, and found it hard to relax in my spare time. Really, this should still be in the present tense to some extent as I’m not totally rid of my preoccupation with work, but this is the area in which I feel I’ve made the most progress. I can attribute this to the therapist from a counselling service in Bristol called Off the Record, who I was put in touch with through the LIFT service.

The hardest thing about talking therapies is the fact that not only do you have to get the type of therapy right, but you also have to be able to bond with your counsellor. They are someone you need to be able to trust and get along with to some extent, and this is something that, before Jon, I never really had. From day one I felt like he just ‘got’ me, and was so accepting of all my feelings that I pretty much just cried with relief. After a total of 16 sessions, with two more to go, I finally feel able to engage in more self-care (like relaxing, and eating/sleeping properly), and have broken that burnout cycle, though I haven’t shaken the anxiety 100%. I have more insight into my thoughts and feelings, and this has had such a positive impact on my life. I am challenging my self-harming habits a bit more, and despite having the occasional relapse, on the whole this behaviour has reduced dramatically.

I suppose the reason I’ve decided to start writing about my mental health is due to my counselling with Jon. I realised that more than anything, just having an outlet where I can express myself is massively helpful, and relieves some of the emotional pressure which builds up as a result of my day-to-day life. Seeing as the root of a lot of my problems is that I don’t seem to be able to deal with these pressures in the way that a mentally healthy person might, and so turn to coping mechanisms such as self-injury to process my emotions, it makes a lot of sense to start blogging. This way I’m externalising my thoughts still, but not in a way which is realistically very unhealthy, even if I’m not doing any lasting damage to myself (apart from the scarring which I’ve acquired over the years).

I’d been having a very good couple of months actually, but over the past week I’ve been slipping back into some of the melancholy that I’m unfortunately so familiar with. Last night was a bit of an eye-opener for me, as I had a very sudden and unexpected ‘emotional explosion’, almost. I cried, and screamed, and hit the walls and the floor, and then took myself out for a walk, during which I’m sure I looked disconcertingly unsettled and upset. I don’t want to experience these feelings anymore. It’s been such a long time, and I’m tired. I don’t want to be subject to my depression or anxiety anymore. I want to give myself a chance to heal, and I hope that through writing, I am able to utilise the information I’ve gained during my recent therapy sessions and improve my mental health.

 

I haven’t even started to discuss my mental health in the depth that I want, and need, to, so please expect to hear more from me about particular aspects of my story in the future- depending on my work and university commitments of course. Thank you so much for reading this, and I hope it has helped you as much as it has helped me!

 

Jess