Mental illness (nope, I don't have mental health at the moment)

I've been thinking a lot about ideas around accepting help, asking for help contrasted with autonomy and self-reliance in the context of mental illness. In my own self-critical way I told myself to shut-up and deal with the fact I need help, that to get it I need to ask for it, I don't need to 'prove' I need it and receiving help is difficult and weird but I'm going to have to get used to it. Thinking about this, and thinking about the process of getting better made me draw some analogies with the equivalent process when recovering from physical illness or injury. I used physical illness and recovery as a metaphor for mental illness with a friend and it seemed to be useful, so I thought I'd flesh out those ideas a bit.

In the acute stage of, say, a sprained ankle you need to take meds (anti-inflammatories, pain meds), rest and elevate the ankle, use ice and compression. You will probably need some help with what healthcare professionals call 'activities of daily living' (ADLs) because you can't and shouldn't use that ankle to hobble around to look after yourself. In the acute stage of mental illness you may need meds (which might be different to your usual meds), you need to rest (sometimes resting your thinking and feeling parts requires meds. A chemical compression bandage, if you will) and sometimes you need help with ADLs. You may be able to walk ok but the part that needs rest is the thinking and feeling part, so making decisions, sometimes even simple everyday decision like which tshirt to wear or what to have on your toast, become totally overwhelming.

In order to help a friend in this situation don't just offer to make them toast, say 'I'd like to make you toast, is Vegemite ok or would you prefer honey?' BUT if they say they don't want toast you MUST respect their autonomy (or make the toast but reassure them you won't be offended if they don't eat it - it's like the great post on consent and cups of tea)

Even when these things are possible they might take a lot longer than normal (so don't expect your depressed friend to turn up anywhere on time, and don't give them a hard time for being late, they have almost certainly already done that for themselves).

At some point the acute stage morphs into the recovery stage. With physical injuries this is the point where, if you have sort help from a medical professional, the physio might have given you a bunch of exercises to do. What questions should you ask the physio? How often should I do the exercises, will it hurt or will there just be some discomfort? When should I start to feel better and get full function back? How long will it take me to heal? What are the SMART goals of treatment? What is the long term prognosis?  These questions can and should be asked of mental health professionals. For sure these questions are more difficult in the field of mental health than physical injuries and ailments but it's really important that if you have a therapist you are on the same page with respect to these things. If you aren't recieving treatment and/or don't have a therapist it's just as important to try to work out where you want to be. A psychologist/psychiatrist/therapist may give you specific exercises - what is cognitive behavioural therapy (CBT) but a series of mental exercises. If you doubt this stuff works, or can work for you (which is pretty normal for depressed people) look up the research. If that is too difficult/personal/scary/etc look up brain plasticity (I liked 'The Brain that Changes Itself' by Norman Doidge) and pense on the fact that brains are incredibly powerful - if you can re-wire your brain after massive trauma then we can probably do some of the re-wiring necessary to be able to live and manage our mental illnesses.

Everybody says it, few people do it but WRITE DOWN* YOUR QUESTIONS. Doing this can be really hard when you are in the black pit of despair or when you are so anxious that you are worried about being able to keep breathing, so cut yourself some slack if you can't manage it. You could also enlist the help of a friend to do this. In fact, I have a few close friends and all of us suffer to a greater or lesser extend from mental illness. When we sense someone might be struggling we will often offer to help them make a list. Along the same lines, take a pen and paper to your appointment and try to write a few things down. Even if you ask the therapist what you should write down, it means when you walk out and suddenly realize you have very little memory of what just went on you will have something written to research or just jog your memory. Memory and cognition can be affected by mental illness, and I'm not just talking fear of impending doom or sense of self here. When I'm sick it takes me longer to process stuff, even simple stuff, and there are lots of things I don't remember so keep the pen and paper handy and don't beat yourself up when things don't go as planned.

Where does this get us? Like other illness and injury, there are steps you can take to get better, but healing often takes longer than you want it to. Even after you get back to a functional state you might find you get tired or overwhelmed more easily. As before, cut yourself some slack and surround yourself with people you feel supported but not smothered by. There IS treatment for mental illness. You can get better, even if you don't think you ever will. I have depression and anxiety and the symptoms have ebbed and flowed since my childhood. Sometimes I'm fine and sometimes I'm most definitely Not Fine. If I had proactive about treatment younger I might be better now at managing my 'twins' - the Black Dog and the Monster - but maybe not. Either way I am much better at calling for help now than ever before, I'm much better at allowing myself to heal, I'm still terrified by relapses and with this current relapse I'm trying to work on what might trigger these major episodes so I can avoid, to some extent, things spiraling out of control.

If you, or someone you love, is suffering with mental illness please work on getting some help  <3 p="">


Group Therapy #1


Oh crap, Here I am. First group therapy session. I spoke briefly to the nice psychologist E yesterday for the first time. She encouraged me to come, and here I am. She promised she wouldn't make me, or anyone, speak if they don't want to so I'm scrawling busily on a piece of paper. Busy. Maybe it's just something to do with my anxious self, I'll have to try it next time I'm at a party, instead of the ever-filling glass of wine. Crap. 
I wonder if the guy next to me can read my writing. I wonder what he thinks. I'm scribbling away before we even start and I hope I'm not making anyone else feel uncomfortable. I would be uncomfortable with someone else writing. It is like having someone in the group texting. Consciously I know everyone here is far more worried about themselves, but still, what is the etiquette?. Since I tend to since I feel like I take over in group settings, I'm going to concentrate on holding back and I'm going to use writing to help me fill the space left by talking, left by amusing people, left by emoting messily all over the place.
Nice psychologist E has asked everyone to introduce themselves. Name only, thank gods. I've got this. She started around the other side of the room, will I participate? I pitch my voice low and clear. My professional voice. It carries but is still quiet. That part went OK but I'll keep writing. Now she's explaining that the group topic is 'Values' and she's going through the ground rules. Normal stuff - confidentiality, respect, no mobile phones. Easy. Now Values. What are they, where do they come from, what stops us living according to our values, she's writing on the whiteboard.... TRIGGER.

Then Nice psychologist E started talking about about the fact we tend to beat ourselves up over.... I couldn't really hear her words any more, just the buzzing in my head, tears pricking, her kind voice saying that we are too hard on ourselves. Not me, I need to harden up, I cried in the gentlest of group therapy sessions. Then tears started to really flow the sobs were on their way, I fled. Seeing only the carpet in front of my feet (I'm good at that). Abandoning my shoes which I'd slid off and kicked decorously under my chair ten minutes earlier.