Talking about mental health

In a recent blog post, Cat Treadwell flagged up some of the things that reliably happen if you try to talk about mental health problems.  It is unfortunately quite normal to hear that you are attention seeking, making a fuss, being a drama queen, over-reacting and things of that ilk. It is also equally normal, when people turn out to have self harmed, attempted suicide, or managed it, to find a lot of people wondering why they never said anything and never asked for help. As though these two things are totally unrelated.

Talking saves lives. Emotional support, witnessing, expressions of care and help with the problems that are causing the depression in the first place all increase a person’s chances of survival. Our culture tends to frame mental health problems as personal, but usually it isn’t – poverty, lack of opportunity, poor physical health, insecurity and a lack of dignity all pushes people towards the edges. These are social, systemic things and we could fix them. Western culture makes people lonely.  The solutions to this lie in community and relationship, but if you can’t speak of it, you can’t access that support.

How something is experienced depends a lot on resources. The less resourced you are, the harder a setback can be to bear. So, if you are doing ok, and your friend appears to be in a similar situation and struggling, is this because they make more of a fuss than you do? What’s the bigger picture? Throw in a large debt, a health problem,  an abuse history and the thing you think shouldn’t be a big deal becomes much harder to manage.  When people ask for help we can’t always see the scale of their issues, so it is as well not to dismiss or diminish whatever is mentioned.

Some people are more sensitive than others, but society tends to view sensitivity as weakness. To care, to feel empathy, to be afraid for the world, to grieve over the loss of species, or the homeless on the streets, or the hungry children depending on food banks – there is so much to break your heart over. Increasingly to be viable is to be heartless. To care about anything is to live with a broken heart. If we prized that sensitivity we’d be a lot closer to fixing the entirely fixable woes we create. If we treat sensitivity as a failing, we can only push on to make life worse for each other.

You may think that if someone was suicidal, you’d be able to do and say the right things to keep them alive. What many non-depressed people don’t realise, is that your suicidal friend isn’t likely to pick up the phone and tell you they are going to kill themselves. It’s not what we do. It’s not when the windows of opportunity occur most reliably to save lives. Your very depressed friend might however speak up about some aspect of how they are suffering before it fully overwhelms them.  It may not make any sense to you. It may not seem like a big deal. Often, the life and death stuff is much smaller looking than is really the case.  Respond well to those smaller expressions and the person you are supporting may never end up trying to kill themselves.

Tell someone they are making a fuss, and when they no longer know how to keep breathing, they may remember that, and not reach out for help.

The impacts of gaslighting

I’m writing this post in the aftermath of the UK Prime Minister and other leading figures telling us that when their man broke the rules he wasn’t breaking the rules. Also if we loved our families we’d have broken the rules. Weeks of difficulty seem meaningless in face of this. People who have suffered greatly while trying to do the right thing are reeling, disorientated and in distress. This is what gaslighting does to people.

I know what’s going on and I can see the process. It will have a much harder impact on people who did not think they were being lied to and who trusted this leadership. Gaslighting drives people mad, and I wait to see with a heavy heart how all this will play out. For some people, it will be a quiet fall into despair and dysfunction. Some people will freeze up and become unable to act or make decisions. Some will lose the plot entirely and what they do will be hard to predict. How many in which category? How much mental health damage done? How much more pain inflicted?

My body is heavy and sluggish this morning. I feel exhausted and it is hard to push back and persuade myself to get busy. There are things I need to do, but in face of all this, there are voices in my head suggesting there’s no point even trying. There is no win available. I’ve been a victim of gaslighting before and one of the major impacts of what’s happening on the national scale, is that it is bringing up for me a lot of unwanted memory about how that felt when it happened on a personal scale.

It is so hard to resist – something people who haven’t experienced it tend to under-estimate. Disorientated, second guessing yourself, no longer knowing what to believe or who to trust and feeling like you are losing the plot – it makes a person so easy to manipulate, or just unable to defend themselves.

When everything is this confusing, anything that sounds plausibly like a calm and sensible suggestion becomes incredibly attractive. I worry about what’s going to seem persuasive.

Mental health is a delicate thing. Humans are more inherently fragile than most of us want to believe. Not recognising that is of itself a vulnerability, because when we get into shit like this we can be slow to realise we are being broken and are in danger. But, looking at the distress, despair and confusion in the UK right now, we are being broken and we are in danger and we need to do as much as we can to assert a functioning reality, look after each other and build sanity and mutual support.

Druidry and rescue

This is a tested approach for dealing with someone in emotional crises. In an ideal situation it would just be a case of grabbing some professional help, but mostly there isn’t any of that to be had, so if someone close to you is in crisis, you may be all they have.

This approach needs handling with the calm authority you would bring to leading a meditation or a ritual. That means you may well use your emotional range to get things done, but you have to do so from a place of love, strength and confidence.

1. Make non-threatening physical contact. It helps focus attention. If someone has disappeared into themselves, and isn’t functioning, touch is a good way of getting their attention. Put a hand on their shoulder, hold their hand, that kind of thing.
2. If you don’t know what’s happening, ask, and listen without judgement. Say nothing that will undermine them, or invalidate their feelings. You may not agree with what they are feeling and why, but if you bring that up now you will only make things worse. Don’t criticise, avoid anything that could be taken as you saying these feelings are not reasonable or valid – you have to start from where the person is right now. No one is ever rescued by being made to feel that their emotions are somehow wrong. Your understanding is essential.
3. Validate their feelings. Tell them you understand why they feel as they do. Recognise the context in which this is happening to them. Empathise with them. If they don’t talk or you don’t need to ask, verbally empathise. Tell them as much as you can about what you understand of what’s happening and why it’s a reasonable response.
4. Using your empathy, you need to persuade the person that you are inside this situation with them. Not that you feel exactly the same, but you are in there, feeling what is happening. You may need to cry for them, but be careful not to make it about you.
5. Refuse to leave them in this place. Tell them you are with them, and that you can get them out. Believe that you can walk them out of this place. One breath at a time. One step at a time. This is where your pathworking/ritual skills really come in. You have to walk them out. Keep it in the present tense, don’t talk about the future too much. Take a ‘this is what we’re going to do right now,’ tone. Keep it simple. Reassure them that they can get through this. The rest you will have to make specific to what’s happening, but it is your empathy and your being in there with them that will enable you to pull them out a little way. You do not need to fix everything right now, you just need to get your person to engage with you and consider that things could be better. Your love, determination and compassion are key here. Don’t use emotional blackmail. It is ok to say ‘I need you’ or ‘I don’t want to live without you’ but don’t say ‘stop doing this to me I can’t bear it’ because that kind of thing will push them deeper in. Make it about them and what they need. They probably do need to feel needed, but not wholly responsible for you.
6. As soon as you have them engaged with you, make some physical interventions. Do things that will be grounding and physically supportive – hot drinks, food, a blanket, getting them to bed, or under a shower, or into a bath and fresh clothes. Brush their hair, massage their feet, make them a hot water bottle, get them outside for some fresh air, or to a window. From this point onwards, focus on physical care – it supports mental health, is a good expression of love and support and creates space in which they can keep talking. Encourage them to keep talking, but don’t push hard, talking is often exhausting when in crisis. It may take a few rounds to deal with what is happening.
7. When things are stable, consider the underlying issues and what can be done to tackle them. Do not try and do this when the person is in crisis, they won’t have the resources and may be overwhelmed and intimidated.

Lockdown and mental health

It has worried me from the start that politicians aren’t factoring mental health impacts into their choices. I thought today I’d talk about some of what I can see happening, in the hopes that if any of you are experiencing this, there will be some comfort in identifying the mechanics. This is UK based but may apply other places.

We’re social creatures, so being asked to isolate is really hard. Doing it heroically to save lives is feasible, most of us can get behind that and sustain it. Doing it when economically based contact is allowed, but love is not, is brutal. We can go back to work, but we cannot go to family, friends and lovers who do not live in the same house as us. We are allowed our economic relationships, but not the ones that matter.

None of this ever made any sense. The biggest source of spreading is households. If one person gets it, everyone gets it because most of us don’t have room to isolate from our families. We should never have been asked to do this. Ill people should have been isolated in medical facilities, keeping their nearest and dearest safe. If you have vulnerable people in your household the advice has been to go to work and isolate from them at home. Technically difficult, and emotionally harrowing. We should be able to cling tight to the people we love, and be confident we can keep them safe.

Big events with hefty financial aspects were allowed to go ahead when they should have been cancelled. Plane loads of people from virus-afflicted areas were allowed in unchecked. We were put at risk, all of us, for the sake of money. This kind of treatment will impact on your mental health. We’ve been lied to and blamed, over and over. This is gaslighting, and it makes people mentally ill.

The whole thing has been organised the wrong way round from the beginning. We should have been protecting close relationships and getting people away from numbers of strangers. We’re safer when we can assess our risks together. The friend I can talk to about how we handle this is far less hazard to me than the stranger who coughs on me in a supermarket. Not being allowed to keep the people we live with safe has massive mental health implications for many people, as well as the hideous virus implications.

Usual mental health advice is all about staying connected with people who can support you. We know what people need to be well, but that knowledge has been ignored throughout this crisis. If we put mental health first, we give people resilience. If we had protected intimate relationships and sacrificed economic ones, we’d be better off. If we had done this the other way, people would have felt less need to push back against the rules.

Usual mental health advice also tells us to get fresh air and exercise. The mental health of people with no gardens, and people living in cramped conditions is not being talked about. It should always have been ok to sunbathe at a distance from others. It should never have been ok to force non-essential, usually low paid workers to keep working and commuting. One of these things runs the real risk of spreading disease and the other, simply does not.

Faced with political choices where you and your loved ones are at risk, and you can’t do the things that might sustain your mental health – little wonder if many of us are suffering. We should always have been putting life ahead of money, and mental health is a key part of life, not some kind of luxury extra for the better off.

In need of wildness

I was struggling long before lockdown with the need for wildness. I live in a beautiful part of the world, but the car noise, the careless walkers who leave bags of poo in their wake, the cyclists who treat ancient monuments as obstacles and things of that ilk had been getting to me for some time. I craved a landscape with fewer people in it, and more wild things.

Then we hit lockdown and everything got worse. The main walking and cycling routes close to my home are busier than ever in the day. Not wanting to add to that and finding it stressful, I moved to twilight walking, but as it has got warmer, ever more people are about at the end of the day. I used to spend hours walking, and the loss of time in the landscape has left me depressed and disconnected. On top of that, poor circulation and/or low blood pressure have caused me sleeping problems.

This week I decided to make some radical changes. So, rather than getting online when I wake up in the early hours, I got my walking boots on. Tom and I went out. The first time, we saw no humans. The second time we ran into a couple of people, but compared to how many folk there are out in the day, it was nothing. Narrow paths I would not have risked in the daylight became totally socially distanced. The world that I had lost opened up to me again.

I came home with the dawn chorus, euphoric. I came home able to sleep, both times, which means my sleeping has radically improved, so my head feels clearer. A tension is easing out of my body, that had come from feeling disconnected from the land. With more time outside and better access to the wild, I am more myself again and lockdown is a good deal more bearable.

There is also more wildness at night – foxes and hedgehogs, owls and others. The dawn is full of birds, and there are lots of wildflowers to appreciate as the sun comes up. With almost no other people out there, the landscape seems wilder. In darkness, familiar places become less so – there’s a lot I can work with here.

We don’t have a garden, so an hour of exercise might be considered the proper amount of outside time we can have in a day. Although guidance around how long a person can be out for varies. An hour is not enough for my mental health. I can’t walk as far as I need to in that time and it has really taken a toll on me. But if we set out in the night and see no one, I can’t see it matters how long we walk for.

I’ll keep doing this long after lockdown – walking to meet the dawn has changed my relationship with the place I live. I feel re-enchanted. Being liberated from the presence of people I have no interest in seeing is a great relief to me. In the silence, with the wild things and a most excellent walking companion, I no longer feel so lost.

When you lose your mental health

It isn’t always obvious that you are in crisis. From inside a mental health crisis, what you are doing and feeling may well make perfect sense. Lockdown may make people more vulnerable to suffering the consequences of not knowing you are in trouble,  so I thought I’d talk about a few things to watch for, in yourself, and anyone you’re interacting with.

Paranoia is a likely consequence of poor mental health. It’s a form of anxiety, and right now it will be made worse by lack of contact with people who can offer alternatives, plus the vast array of conspiracy theories out there. If you are in a country whose government is handling the pandemic badly and people are dying because of that, then some amount of paranoia may be appropriate and reasonable. When it takes over your entire thought process, then you are in trouble, but this is hard to spot from the inside.

Catastrophising is another common consequence of failing mental health. You focus on the worst possible outcomes and start to see them as likely, or inevitable. Again this may seem wholly realistic. If you’re starting to feel like lockdown will never end, that you and everyone you have ever loved is bound to die, then you are catastrophising. It is a persuasive line of thought, but that doesn’t make it a definite truth.

Overwhelming futility – this one comes from depression, but it can pair up easily with paranoia and catastrophising. It feels like there is no point doing anything. At the extreme end, there seems to be no point getting out of bed, or eating. This is likely to turn up with, and be reinforced by overwhelming feels of exhaustion and leadenness.

The best solution I have found when dealing with this in better times, was to have people you can trust to hear you, not make you feel ridiculous and help you get things back in proportion. However, there is no knowing right now who else might be driven around the bend by what they are experiencing. If we dig in with these experiences together, we can amplify them for each other. It’s difficult to keep things in proportion when the world is such a mess. It’s hard to be certain that any kind of hope or optimism is rational at all. But in terms of surviving and being able to function, some kind of hope is essential. Hope as a deliberately chosen path, despite all the evidence that does not support it, might be the most insane and most healthy thing you can go for right now.

The other thing to always consider with failing mental health, is to focus on the practical and physical things. Look after your body, eat good food, rest, get exercise, get some sun if you can and some tree time. It gives your mind something productive to focus on and you can make a difference to yourself and those around you with a focus on bodily wellbeing. Focus on surviving and staying able to function. Hopefully there is a far side to all this where healing will be possible and we can rebuild ourselves. Human minds are fragile and damage easily, but are also resilient and can recover.

Trees in isolation

I am lucky in that the living room window of my small flat looks out onto a view with trees in it. There’s a bit of sky. I sit at my computer to work, and I am facing a horse chestnut tree. Often that tree is full of birds. Over recent days, the leaves have been unfurling and they will be fully open in a day or two and after that will come the flowers.

I feel very fortunate. For many people living in flats right now, there is nothing good to look at outside the window. There is nothing to rejoice in and be uplifted by. We know that green space is good for our mental health, but the way we’re responding to the virus is overlooking this, especially for the poorest of us. What do you do if your home is small and overcrowded, with no garden, no space indoors to exercise, you can’t travel to a green space and there isn’t one where you live?

If we had plenty of green spaces, everyone could get out to exercise and take what care they can of their mental health and there would be no crowding of popular spots. In practice large gardens and access to green spaces go with affluence. There is a huge difference between staying home with a garden, and having no outside space you are entitled to be in. There is a huge difference between a view with some trees in it, and a view of other buildings. The mental health implications of being trapped with no green space, are huge.

What social distancing and isolation means depends a lot on where you are doing it, and that in turn depends on how rich you are. What’s happening now is that the impact of pressures and inequalities that were always there are becoming that bit more obvious. The lack of green spaces for many has always been a mental health issue. The cramped, inadequate conditions many people live in, have always been a problem. Mental health problems have been at an epidemic level for years. Stripped of our coping mechanisms and forced to stay in, many of us who were in challenging situations to begin with will be forced to suffer more.

Access to trees should not be a matter of wealth. Green space should not just be a middle class thing, it should be for everyone. Green spaces help us stay well, in body and mind and this has never been more visible than it is right now. Access to trees is a facet of social justice that often gets overlooked, but it is part of a great deal of systemic injustice that urgently needs changing.

Struggling with mental health

I wrote this in the middle of the night recently, crying, unable to sleep, overwhelmed with panic and despair. The first version went up on Facebook. I’m mostly trying to out a brave face onto my online presence – easy to hide behind a screen. But, I doubt I’m the only one feeling this way and I think it needs talking about.

TW – Suicide issues.

Like a lot of people, I was suffering from anxiety and depression before the virus. There has never been much help available for us, and now there will be less.

Many of us have lost key things that were keeping us going. We may express hurt over that online – the loss of the gym, the dance class, the pub time, the live music – we may not be being super selfish when we express distress. We may be talking about the things that helped us stay alive. Depression also kills people. Knocking people back for expressing distress or difficult, really doesn’t help.

It’s really hard for me, reading people saying ‘stay in’ and ‘don’t see anyone’ with a clear message that anything other than total isolation makes you a terrible person. I’m really struggling with feeling like a terrible person, I expect I’m not alone. I don’t do much going out at the moment, and I’m being careful and have been for weeks. But I’m also not sleeping, and crying a lot, and terrified of being trapped in this flat and what that would do to my already poor mental health.

Tom has some serious anxiety issues and for him, being trapped in a building is deeply problematic.

So maybe don’t share the memes about how all you have to do is sit on the couch, it isn’t that hard. For some of us, isolation could well be a death sentence.

And yes, lots of anxiety about how selfish I am in not wanting to end up suicidal. I’ve been through periods of wanting to kill myself before now, I’m fighting not to go back there. I’m seeing people online hoping the virus will take them quickly because they’ve already lost the will to live. I see the same thoughts creeping in with me. ‘Selfish’ can be something of a trigger term for me and again I suspect I’m not alone. I think people who kill themselves often do so because they think its the best thing they can do for the people around them. What else is there, if the things you do to try and stay alive are deemed selfish?

I know many of you are new to massive anxiety, and you just want everyone else to be more sensible so you and your loved ones are safe. Of course you want that. But some of us were only ever holding on by our fingertips, and now things are worse. Please, when you go online to vent your fear, consider how it might sound to someone who is having a mental breakdown. Someone – for example – for whom going outside for a run, or a walk is the one tool they have left to manage their failing mental health.

Your suicidal friend probably won’t tell you how they feel because that’s part of how this illness plays out. They won’t ask for help, especially not if what they need is time with another human being. You won’t know who is in trouble, most likely. Yes, isolation saves lives. Kindness also saves lives, and your depressed friends need to know that their lives matter too and that they are not failing as human beings for wanting or needing things that are difficult at the moment.

Cure or Management?

There are many conditions that cannot be cured. For every one of those conditions, there are supposed miracle interventions, that people will insist can save you. It’s particularly bad around mental health because rather a lot of people believe that medication will cure you of depression and anxiety. For many of us, it doesn’t. Management is kinder, more realistic and more useful than chasing after a fantasy cure, often. For most people, medication doesn’t cure depression, it’s just a tool to manage symptoms.

I have been on the wrong end of this. I’ve let myself believe that if only I tried harder, ate better, exercised more and worked on myself, that I could beat depression. And then every time it’s come back, I’ve felt like a failure on top of everything else. I’ve watched friends not being cured by meds. I’m also aware of numerous friends for whom the meds are a good tool to help manage things. They aren’t fixed, but they are able to live with their illness.

The idea of a cure can be a way of making a sufferer responsible. If a cure exists, and you aren’t doing everything you can to find it, are you really that ill? Are you being responsible around your illness? Never mind that chasing fantasy cures is exhausting and demoralising. Never mind that help to deal with ongoing problems would be more useful. Focusing on finding a cure can make it harder to deal with what’s really going on, and can add to feelings of guilt and despair. No one’s mental health is improved in this way.

If suffering is somehow the fault of the person experiencing it, then well onlookers need not worry – it won’t happen to them. Belief in cures can be part of what keeps well people feeling safe in face of other people’s distress. Confident that they would get out there and be cured, they don’t have to empathise with suffering, do anything to help, or even treat the sufferer kindly. It is a cruel way of relating to illness.

Grasping that I may never fully get over depression and anxiety was a powerful moment for me. It came up when reading Down Days by Craig Hallam. He talked about not expecting to ever truly recover, and a weight lifted from me. Perhaps not getting better is not some failure – moral or effort based – on my part. Perhaps I do not owe it to anyone else to become well. Perhaps focusing on what I can do to be as functional as possible is wiser. If I treat this as something I will have to navigate for the long term, perhaps I can be more patient, kinder to myself and more comfortable from day to day. The idea of a permanent fix has distorted my sense of what I’m dealing with. Let that go, and I can respond to what’s real and consider what’s truly possible.

I’m better than I used to be. I have no doubt that one of the reasons I’m better is that I’ve become less tolerant of people who want to tell me what I should be doing. I’m no longer open to people harassing me because I don’t manage my mental health in the (uninformed) way they think I should. I’m not internalising the voices that tell me I’m a failure for still being ill.

Building an Echo Chamber

If you’re a well-meaning person the odds are that you’ve wondered if an echo chamber is a problem. You may have felt obliged to make sure you’re hearing what the haters and fascists amongst us are saying. How can you be a good person if you aren’t open minded, aren’t listening to difference, aren’t open to other opinions?

This is something I’ve talked about before. It is possible to experience diversity and difference without engaging with hate. Exposure to diverse thinking is good for us. Hate isn’t.

We are all deeply affected by our environments. It’s a massive influence on our psychological development as we grow up. As adults we may think we’re immune to what’s around us, but this isn’t necessarily so. That which becomes normal to us will shape our choices and behaviour. Even if that means we come to feel that donating to foodbanks and seeing homeless people in the streets, is normal.

Human minds are quite fragile, easily influenced and easily damaged. We all have enough ego not to want to believe that. We all want to think we are strong, free-thinking individuals who would not be sucked in to something vile. The odds are, if you’re reading this then you’d picture yourself in Nazi Germany helping Jews escape and working with the resistance. You would not picture yourself at a rally screaming in ecstasy at Hitler. Environments can be intoxicating. From the playground onwards, our desire to belong and be part of something can distort our identities and shape our behaviour.

Having had my reality broken, I am uncomfortably aware of how fragile my mind is. My mind is desperately fragile.

It may be that exposure to hate and misery does not make us want to join up with the haters. It may instead grind us down, making us feel powerless and like there’s no point doing anything. We may be overwhelmed with grief, or rage, or frustration. We may turn on the haters and hate back with all the vitriol we can muster. All of these things mean that what we’ve been exposed to is impacting on us.

One of the ways in which you can protect your own mental health, is by making careful choices about what you expose yourself to. Most of the time, most of us do that. You may, for example, have already made the decision not to watch violent pornography. You may have chosen not to go to Trump rallies. I imagine you wouldn’t go to a bull fight, or an abattoir, or to take a holiday in a war zone or disaster area. When things are large scale and obvious, we are often better at recognising the threat and keeping away. It’s the smaller, everyday nasties that we can persuade ourselves we ought to engage with. We should be informed. Educated. Aware.

Turning away from everything is no kind of answer. Pick your fights and causes. Be prepared to know about and take on a few issues you can manage. Raise awareness without traumatising people. No one, for example, needs to see images of animal abuse in order to sign petitions. It is not your duty to know about every terrible thing going on in the world. It is not necessary to listen with compassion to every troll and every hater you encounter.

It is ok to choose to live in an echo chamber. It is ok to choose to protect your mental health so that you can continue to make your contributions. It is ok to choose not to know about everything. Often it is better to focus on taking care of what you love, rather than being paralysed by things you can do nothing about.