What if we took mental health seriously?

At the moment here in the UK we have badly funded mental health resources and long waiting lists for anyone in crisis trying to get help. It’s an appalling situation. But, what if we didn’t even start at the point of trying to fix people’s mental health? What if we took mental health so seriously that our laws, culture and ways of living actively supported us in getting to be well? What would need to change?

Stress, and particularly stress caused by poverty and insecurity undermines mental health. If we wanted as many people as possible to be as well as possible, we’d have to deal with those problems. The money and resources exist. Universal Basic Income would remove a lot of fear from people’s lives, which would have wide reaching mental health benefits. 4 day working weeks, and work policies that promote mental health would be great. Shorter shifts, better breaks, kinder and more humane working conditions would all help considerably.

We’d have to take the climate crisis seriously. Distress around the loss of species and habitats is affecting many people’s mental health – especially young people. The insecurity and uncertainty caused by climate change impacts mental health. Flooding, drought, hazardous heat waves, crop failures – we can’t afford this level of uncertainty and threat. We can’t protect our mental health without protecting the environment.

Everyone needs green space where they live and free and easy access to that space. The relationship between mental health and green space is known. We also have better mental health when we have time, energy and opportunity for exercise – being able to move about outside is the cheapest and most sustainable kind of exercise available. That should be on everyone’s doorsteps. To improve everyone’s mental health, we would have to fill our towns and cities with plants and set more space aside for walking and cycling.

We need healthy bodies – good food, clean water, prompt medical care. We need the time and resources to be able to take care of ourselves, which isn’t available if you work long hours for not much money. A great deal of depression and anxiety is caused by being ill and being in pain. Taking mental health seriously means we need a culture of physical wellness too – you can’t separate body and mind.

Good mental health also requires social engagement and feelings of belonging. It calls for dignity and a sense of self worth – much of which would be tackled by dealing with the points I’ve made above. We need laws that uphold dignity and treat people as valuable and not disposable. We need systems that do not punish people for the accident of their circumstances.

We have to stop seeing poor mental health as a sign of personal failing or weakness. It’s a symptom of sick systems, broken relationships and inhuman ways of treating humans. To change that, we have to start thinking that kindness is better than exploitation, that wellbeing should not be a privilege for the few and that consumption is not the answer to everything.

Different flavours of panic

Not all panics are the same. I’ve been exploring the different ways in which panic shows up for me and what the implications are for dealing with it. Panic can happen for all sorts of reasons, and my list won’t be exhaustive or true for everyone but I hope by sharing it I can give someone else a place to start.

Hormone panics. I’m somewhere in the menopause sea (I have no idea where). I get intense hormone blasts sometimes, and they tend to make me panic. Recognising them as hormone-induced helps me weather them. Otherwise, soothing drinks are about the only thing I’ve found useful.

Overload panics. These happen when I’m exhausted, mentally or physically. Just hitting exhaustion can be enough to do it. If some extra thing needs doing when I’ve already hit my limits, this will also really panic me and make me largely useless. My best coping methods are to be clear with the people around me when I’m approaching the edges, and to be clear that I’m having overload panic if it kicks off. I have to accept that I can’t push through these to do the things, I have to wait until I’m better resourced and calmer.

Panic caused by triggers. These are often much harder to explain to anyone else while they’re happening because they bring up intense intrusive thoughts and flashbacks. The first priority is to get away from whatever seems unsafe. I’m working on being clearer with anyone who might come into contact with these that I need them to help me feel safe and to be quick to react if they’ve accidentally triggered me. Feeling safer will bring the panic down, and without that I’m stuck and can spiral through panic, intrusive thoughts and flashbacks for hours.

Triggered panics fall into two broad categories. One is where I feel to blame over things that aren’t my fault, or responsible for everything. The less power I have to sort things out, the more triggering this is. The second area is around loss of body autonomy. The conventional wisdom around this sort of panic is that it is down to the person experiencing it to work on recovering. On the whole I think I’d do a lot better without being triggered in the first place, so, I’m talking more about my boundaries, what its fair for me to take on, and what I need to have change. I’ve dealt with people in the past who triggered me and were very clear it wasn’t their job to do better. I’ve come to the conclusion that if anything of that shape happens again, I will remove those people from my life with all speed.

Part of what got me damaged in the first place was people ignoring boundaries and forcing unreasonable responsibilities on to me. This in turn makes it hard to flag up distress in those areas, making it harder for anyone who wants to not get into that kind of mess with me. With a back history full of being trained that people who hurt me were entitled to do that, I’m re-drawing my lines. People who want my time, care, energy and resources are going to have to treat me in ways that make that possible. Anyone who tells me they can’t be walking on eggshells all the time, or anything similar, will be out of the mix. I can’t afford it, and I recognise, finally, that no one is entitled to treat me as disposable in that way. Feeling worthless is part of what underpins the panic, but I do not have to accept being treated as worthless and I can say no.

Mental Health Observations

I know why I’m in this mess, and there are two key strands. Strand 1 is my history, and the traumas and stresses in it. I did not get ill on my own. Strand 2 is that there has never really been a time when getting well and looking after me seemed like the most important thing. Strand 2 is very much a consequence of strand 1.

Being told I make a fuss is a whole-life issue. As a child I learned I had a low pain threshold, and over-reacted. Accusations of attention seeking, melodrama and emotional manipulation have happened repeatedly. So, my first response to distress is actually to hide it, partly because I’m afraid I really am doing all of those things, and partly because when I’m in distress, the last thing I need is to be accused of making a fuss for attention or being unreasonable. I’ve become the first person to diminish my own distress and I am easily persuaded that anything and everything is more important than whatever I happen to be feeling.

It doesn’t help that my work situation makes it hard to take time off. It doesn’t help that the publishing industry is a mess and it is very hard for anyone to make any money doing this – the stats are out there, I’ve talked about it in other posts. It doesn’t help that most outfits only want a few hours here and there of marketing and social media work so I have had to do lots of jobs to make ends meet, which takes far more energy than doing one job for the same hours because there’s so much more information to keep track of. At one point a few years ago I was doing 7 different jobs. It was hell and it still wasn’t enough to get close to an average wage.

I don’t get enough time off, or rest, or restorative stuff. I’ve known this for some time. The difficulty is turning that knowledge into action. Can I persuade myself that being well is more important than anything else that comes along? Can I hold boundaries when other people want more from me than I can afford to give? Can I deal with the voices in my head that yell ‘you are being emotionally abusive’ if I express distress or need? I don’t know. It’s a hard fight, and it’s a fight I have to take on when I’m at my most exhausted, currently. In many ways, accepting that everything and everyone else is more important than my mental health has always seemed like the easier, safer choice. In some contexts, that has definitely been true.

I’ve got to the point where not being able to push through is a real issue. I can’t keep going by will alone, because I’m exhausted. I don’t have resources to deploy, no matter how important situations seem. I’m struggling to work, and if this gets much worse, working is going to get ever more difficult. I am running out of options, and trying to persuade myself that this is not me making a fuss, or being lazy, or not trying hard enough. Either I get on top of this, or I hit the point where I really can’t get out of bed, and I do not think that point is so very far away.

What I’m hanging on to right now is a very powerful instruction to survive. It’s something to hold as a shield between me and all the things that push the other way. It might be enough to enable me to turn things around. It may not be melodramatic to say this is at a stage where ‘not survive’ is a potential outcome otherwise.

Beyond Burnout

At the weekend it dawned on me that I couldn’t imagine anything good. I couldn’t think of anything restorative that I wanted to do, or that might make me feel better. Nor could I imagine ever feeling good or happy again. I can’t carry on like this.

I’m not even sure when I burned out this time, except that it was months ago. Instead of resting and recovering – my normal burnout response- I kept slogging on. There were reasons and I know what they were. I’ve never been to the land beyond burnout before, but it is not a pretty place. There’s very little aside from distress that I can actually feel and I’m stumbling around like some kind of half dead zombie thing, and have been for a while.

This is not a place from which it is easy to plan an escape. I have no idea what would make me feel better, so I’m going for the most reliable responses to mental health setbacks – more time outside and more rest. My energy levels are very low and have been so for months. Aside from weekends, I’ve only had a couple of days off this year because I couldn’t get on top of things. So I’m going to push myself over the next couple of days so that I can have some days off, and maybe some rest will help me plan things a bit.

Everything feels like pushing a rock up a hill. The hill is steep. My boots are made of lead. The rock is angry and hates me. There’s no joy in anything, and I am perpetually exhausted, and it is pretty obvious at this point that pushing the angry rock is not getting me anywhere better. Helpfully there is a guest blog coming up and I’ve planned some smaller blogs, so, this continues as does the Hopeless Maine blog – thanks to contributions from others. I’m going to take a break from social media, and from news, and I’m going to try not to feel totally responsible for looking after other people. So if I am quiet other places, this will be why.

The quest for dopamine

Every time I go a round with mental health difficulties, the question of whether I should be on meds comes up. What I really want to do is fix my underlying issues and have the space to do that. For me, seeking a chemical intervention does not feel like doing something that would help me, it feels like being more convenient to everyone else, and that’s part of my fundamental problems in the first place.

I don’t have a great relationship with my own body chemistry. However, if I do the right things around diet and exercise, if there are cat snuggles and I get enough rest, I can make most of it work. I put a fair amount of effort into this sort of thing. However, having poked around online to learn more about what different chemicals do in the brain, I realise that dopamine may be a life-long issue for me. I don’t really experience a feeling of reward. Something happens around 20+ mile walks but I can’t do those much of the time. Still, it means I know I am capable of feeling achievement and reward, so it’s there, I just have to make it happen.

It doesn’t matter what I do or how well I do it – most of the time I feel no sense of achievement. All I can see is where I went wrong, wasn’t good enough, could have been faster, better etc. etc. I work hard, and I get very tired and I mostly just feel useless. This, clearly could be better. I have a pretty good idea how I got like this, and I certainly didn’t do it all by myself. But, how to get out of it?

I’ve got two approaches at the moment. One is to challenge the story that is always running in the background – this is easy, anyone could do it, and most people would do it faster and better than you, what you do isn’t really good enough, you’re barely keeping up when you do manage things… it’s hard to feel any sense of achievement with a background story that reiterates that you’re always falling short anyway. I need to examine my expectations and watch my thoughts around this and pull out the stuff that other people have put in my head.

I need to factor in how hard things are – how much work I’ve done, how ill I’ve been, how fast I really went. Because this does actually matter and I need to measure achievement against my own effort, not against the imaginary average person who is about ten million times better at everything than I am. I’m doing this by paying more attention to my own effort, acknowledging my own challenges, and checking in with people I trust about what they think is normal. It will be a process.

At the end of it, I have no idea if I will be better able to experience feelings of reward and achievement, but I’ll certainly spend less time tripping myself up, and I can pull some of the toxic historical stuff out of my head, at the very least.

How hard is it?

If you’re dealing with long term illness, pain or mental health difficulties, it can seem appropriate to try and figure out how hard things really are. How does your experience compare with other people’s? This will likely stem from a feeling that you are making too much fuss, and not being stoical enough. You may not feel confident that you are entitled to ask other people to take your suffering seriously.

Distress is not really a thing that can be measured in relation to other people’s distress. However, the urge to do so comes from experiences like being told you shouldn’t make a fuss because other people are worse off. By this logic, only one person in the world at any given time is allowed to make a fuss!

In any sane and compassionate scenario, what will matter is that you are suffering. If you have to prove you are suffering enough to be taken seriously, there’s something wrong with the situation. If you’ve had extensive exposure to having to prove your discomfort, you may be in the habit of doing it to yourself even when there’s no longer anyone around to suggest that it probably isn’t as bad as you are making out.

Many people have terrible double standards around taking their own discomfort really seriously while being dismissive of everyone else. It is of course the people who know perfectly well that they make a fuss about little or nothing who tend to mistrust other people’s self-reporting. People who are used to being comfortable often treat minor setbacks like a bigger deal, people who are used to being uncomfortable often learn not to let it be the most important thing.

I’ve noticed around my issues that I feel obliged to be able to explain and demonstrate things. If I am upset, I have to make sure that I can reasonably explain why I am upset and I have to feel confident that any normal person would also be upset in the circumstances. It’s never felt like enough just to not like something or be uncomfortable. I’m trying to stop doing this, and to make space for how I feel regardless of whether I can demonstrate the reasonableness of the feeling. I often catch myself accounting what I’ve done against how I’m feeling, like this is an equation to balance, and if I haven’t done enough to feel tired, I don’t feel comfortable stopping.

All bodies are unique, all situations are unique, all minds are unique. What someone else might do is not that useful a measure. How hard it is for you is the most important consideration. But, if you’ve had knocks to your confidence, or don’t get taken seriously, it can be hard to hang on to that. No one else really knows what anyone else is feeling or going through. How hard is it? Really only you can say. Feeling you are entitled to say can be challenging. Trusting that your experience and needs are what matter can be hard if you’ve been taught not to do that.

If you know it’s important to keep a sense of proportion… if you care about not asking too much of other people… if you worry about whether things aren’t as hard as you think they are… trust yourself. You are paying attention, you aren’t being self-indulgent, your experiences and opinions are valid. It’s the people who never worry about these things who tend to make a lot of fuss over very little. Try and work out whose the voices are that tell you your experiences aren’t valid – the odds are there are specific people who have downplayed your distress and treated you like you were playing up the discomfort to get your own way, or get out of something. You don’t owe those people anything at all.

Pain, Shame and Guilt

I think in many ways it’s a reflection of how seldom mental health is taken seriously that we add shame and guilt on top of people’s existing pain. No one who considered themselves kind and well meaning would tell a person with flu to just pull themselves together and try harder as though this is how you get over flu. We don’t tend to tell people whose bodies have been seriously injured that they should ‘man up’. Culturally we do have some serious and parallel issues around how we treat chronic pain and long term disability, but that’s a post for another day.

We treat psychological injuries as though they are personal failures and in doing so, add to the burden already wounded people are carrying.  Telling people the reasons you think they shouldn’t be in pain doesn’t ease pain. What it does do is help that person internalise shame and carry guilt about their own suffering. That in turn makes it harder to ask for help.

Depression isn’t an individual failing. Often the reasons for it aren’t personal, but systemic. Poverty and the stress of insecurity makes people ill. Overwork, leading to exhaustion and burnout makes people ill. Distress caused by mass extinction and climate chaos makes people ill. Being made responsible for things we have no power over also makes us ill. Here in the UK we have a culture of working people to death, blaming them for not being able to find work in a shrinking jobs market, causing poverty and then blaming people for being poor and a host of other such horrors that pile on the misery. The result is that not only do you get to suffer the consequences of stress and insecurity, but you get to feel like it’s all your fault for not being good enough in the first place.

If you do get help with mental health issues, the odds are it will be meds. That’s what we can have. Huge numbers of people are suffering depression and anxiety as a direct consequence of our messed up work culture and precarious lives. How can the answer to such system failures, be chemical? Use it to get by if it helps you, but don’t buy into the idea that meds are the answer here.

We have to stop blaming individuals for suffering and start talking about the way in which our culture is sick. We get less time off than your typical mediaeval peasant. The safety net of welfare is being eroded. We are punished for misfortune and poverty. We don’t have enough green space, enough quiet space or enough time to benefit from exercise. Many of us can’t afford to eat well. It is difficult to be mentally well in such a situation.

Mental health is a collective problem that needs solutions on a societal level. When we treat it as a personal problem to be solved at the personal scale, we add to the guilt and shame that makes people ill, and perpetuate the stories in our culture that are causing bodily and emotional sickness. Mental health is a cultural issue, a societal issue, a political issue.

High Functioning Depressive

For a long time, I believed that the depression I experienced wasn’t that serious on the basis that I am able to keep going and do stuff. One of the classic measures of depression is that it shuts a person down – can’t think, can’t concentrate, can’t even get out of bed some days, no energy, no anything. I’m deeply grateful to author Craig Hallam for gifting me with the term ‘high functioning depressive’ because it’s reframed my whole experience of being depressed, and changed my sense of self.

I’m good at hiding things. In most ways I’m a very honest person, but when it comes to how much I’m suffering, I lie with every part of myself. It means people can know me pretty well and not know what kind of distress I experience. I’m good at keeping going. But then, I’ve been dealing with fatigue since I was in my teens. I’ve lived with pain, exhaustion and depression my whole adult life and I’ve learned to work around it. I have a huge amount of will power, a vast amount of discipline and self control, an unusual amount of determination and these combine to make me look fairly normal and functional. It is often less expensive to hide this stuff than explain it when I am in trouble.

From the outside, it is hard to see what anything is costing me. Blogger and author Merry Debonnaire suggested that I start measuring the costs in terms of distress and exhaustion. Partly to get this in better perspective for myself. Partly to help me explain to other people what I’m dealing with. There are mornings when sitting at the computer to work is as exhausting as a ten mile walk on a more functional day. There are days when getting to the bathroom is like trying to climb a hill. There are times when doing ordinary things is like trying to do the last mile of a twenty mile walk that has broken my body already. It’s a useful re-framing.

There are very few people I will spend time with when I’m in trouble, and who I feel safe letting see that. I also get a lot done. That means from the outside, it is really hard to measure how depression, anxiety, pain and fatigue really impact on me. For some people, that’s going to be confusing. For some people, it will make me seem fake, or attention seeking, or fuss making. The notion that you can look at a person and determine that they ‘don’t look ill’ and judge accordingly is a really suspect one. The idea that what a person can do on one day is a fair measure of what they can do on another also needs flagging up as problematic.

On a good day I can walk fifteen or twenty miles. Days that good are rare. On a good day I can work for eight or ten hours and I have phenomenal concentration. On a bad day I still have a longer concentration span than most people. What one person can do when they are well or ill is no measure of what it’s fair to expect from another person. We’re all different, and in unique circumstances. What one person can do on a good day isn’t a measure of what happens on a bad day.

Depression is often framed as an invisible illness. It isn’t invisible. It’s there to be seen if you look for it. There to be understood if you listen. It is however an illness that can be very easily dismissed and ignored, by anyone who finds it more convenient or comfortable to deny that there’s a problem. A person not conforming to expectations is not automatically a person who is well and lying, or making a fuss.

Depression and communication

Depression can make communication very difficult. This is why encouraging depressed people to ask for help isn’t actually that productive – if you can’t communicate, you can’t flag up distress to other people. Putting the onus on depressed people to actively seek help doesn’t solve much, adds to the pressure and it reinforces the idea that solving depression is a problem for the individual sufferer.

People who are deep in depression don’t always know that’s what is happening – especially if they haven’t experienced it before. Around communication, depression can manifest as having nothing to say, no ability to put what’s happening into words, feeling overwhelmed by the idea of trying to have a conversation with anyone. Not being able to do the things you normally do to express yourself. For me, one of the first things to go is singing. I can’t always speak – my throat literally closes up. I don’t write about depression when it is drowning me – I tend to blog when I’m surfacing, or when things are less bad. On the worst days, I can’t talk about what’s happening. The worse it is, the less able I am to ask for help.

Not knowing that the loss of communication skills and the feelings of being overwhelmed even are depression symptoms means that someone suffering won’t know that they might need help. It also means that if you see someone go quiet, you won’t necessarily get much insight by asking if they are ok – they may well not be able to tell you whether they are ok. It’s worth asking anyway, but don’t assume that an ‘I’m fine’ means the person is actually fine. They may be in trouble and largely inarticulate.

Talking about distress when you aren’t ready to doesn’t reliably help. It can feel like having to perform your pain for someone else. It can feel like you have to explain what’s going on – and you may not have the resources to do so. Pushing people to talk about their feelings won’t necessarily help them.

In these kinds of situations, small gestures can be really powerful. Text your silent person. Send them photos of cute things. Bring them chocolate. Offer opportunities to go out, to talk, to do something you would normally do together, but don’t take it personally if they decline. Make a path for them to come back when they are ready. Make it clear that your care for them is not dependent on their being able to perform for you. Keep talking. If someone who matters to you falls silent, don’t wait for them to ask for help. They may not be able to do that. Get in there in whatever way you can, and be as patient as you can be.

Environment and health

‘What is wrong with her?’ They asked.

Not ‘what is wrong with her environment?’

It’s a vitally important question and one that we too often overlook. When it comes to mental health and physical health alike we’re too quick to focus on the individual who is suffering and far too unwilling to consider the context.

Poverty, work stress and insecurity make people ill. We know this. The evidence exists. Poverty equates to poor diets, lack of access to green spaces and other insufficiencies that undermine the health of the body and the mind. We know that it is lack of control over your situation that causes the most stress and the most damage. We know this is why people in insecure jobs, zero hour contracts, short term contracts and at high risk of debt suffer from stress and all the illness stress causes. We know, but when people break, we make it personal, individual, specific.

We also know that people are happier and healthier when they have access to green spaces. We’ve seen this around lockdowns. The evidence was there before 2020 from studies from all over the world. Without access to green spaces, our health suffers. And yet, if we get ill for lack of time outdoors, this won’t be part of the discussion we have with our doctors, or the welfare system.

When children can’t cope with sitting for long periods at school, we ask what is wrong with the child, not what is wrong with how we approach education. When people aren’t especially productive in the workplace, we ascribe it to things that are wrong with them, and not to the workplace. When people don’t engage with each other socially, we blame them, and their relationship with screens. We don’t ask what’s creating the pressure to behave that way in the first place.

The environments in which we exist, work and attempt to live are not inevitable. They are co-created. They are often dictated by those with the most power and forced upon those with the least. But even so, they can be changed. We need change. In the meantime, resist the temptation to blame individuals for things that are done to them. Look for the collective in both the problems and the solutions. Support other people where you can, share resources. Resist the culture that says any of this can be fixed through hard work – this is a lie. Resist the culture that says suffering is good, or necessary – this is a lie designed to keep the many placid as we work for the benefit of the few.

Health – for the body and the mind, are very basic needs and essential for human flourishing. We need to live in environments that support human health, not spaces that undermine it.