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="">

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