Mental Health Day 2019

So it seems World Mental Health day was the other day and, as is normal for someone with ADD (belonging to this group, as I now know I do, I’m going to admit and proclaim this whenever possible!), I really wanted to post something about it, but didn’t get around to it. So here’s a few thoughts, a bit late but who cares because Mental Health Day should be every day.

Content warning: I will talk about suicide and some of the various manifestations of mental health issues, not in particularly graphic detail but with honesty, so if you’re feeling sensitive right now, please know it’s ok not to read on.

First, a quick glossary for those who may not have had contact with this world. When I say mental health issues, it can be any of the following, and more: depression, anxiety, OCD (obsessive-compulsive disorder), PTSD (post-traumatic stress disorder), ADHD / ADD (Attention-Deficit and Hyperactivity Disorder – this can manifest with hyperactivity or simply as a lack of focus, also known as inattentive type / ADD), Bipolar (previously known as Manic Depression), Borderline Personality Disorder, self-harming, addiction, schizophrenia, psychosis, eating disorders or any of the other many, many expressions of some imbalance in ourselves.

I’m not going to define them all here, partly because there’s not space in a short (ish) blog post and partly because the way these things manifest can vary so wildly from person to person, and I think it’s dangerous to pin down a definition to x, y and z. Someone can be reading and think, “oh, I thought I had depression but it’s not quite like that…” These conditions can manifest in very noticeable ways, or be almost undetectable to anyone but the sufferer. If you get on with your life and put on a brave face, but you’re crumbling inside, it doesn’t make you any less ill or less valid than the person who’s so ill they had a breakdown and ended up in hospital.

Let me be very clear: if something from this list resonates and you think you might have something going on, don’t let anyone tell you you don’t. Research for yourself, as much as you feel able to, and find a good health professional, which may take a long time – but please, please persist because when you find the right treatment, it will change your life (more on this later).

I share from time to time about my own mental health journey, but it always bears repeating. Some people are apprehensive about sharing these issues, for fear of judgement and prejudice from family, friends and work situations. Sadly, they’re right to be afraid. People do judge harshly, frequently misunderstanding and jumping to very wrong conclusions about what these issues are.

Anyone who’s had any dealings with mental health will know what it feels like:

– But you have a wonderful life! You can’t be depressed!
– Count your blessings, you’ll feel better!
– Cheer up, it might neve happen! (Ugh)
– You just need to grow up, pull yourself together!
– Life is hard, we all get depressed, you just have to get on with it!
– Think about your children / partner / dog, you have to stay strong for them!
– You need to get your shit together!
– Why can’t you be more like your brother / sister / mother / father?
– There are people in the world with much harder lives, you don’t see them complaining!
– What’s your problem? If I had your life I’d be laughing!
– What’s WRONG with you?!

I could go on, but you get the point (I hope). There is no counting your blessings when your chemistry literally prevents you from feeling anything but numb hopelessness. When your mind is whirring so fast you can’t get a calm, logical thought in edgeways. When it’s OUT OF YOUR CONTROL. Mental health issues affect the mind and emotions, but it doesn’t follow that you can control them with your mind. That’s kind of the point. And we really don’t need people making these sort of comments because our own brains do that ad infinitum – even when we have come far enough to know it’s NOT our fault, the thoughts still come. I’ve heard this described as the Second Arrow. The first arrow is the pain of the condition itself, but our brain often insists on driving home that second arrow of guilt for feeling bad, questioning why we can’t pull ourselves together and so on. It’s a kind of madness – would you ever feel guilty for having a headache?!

What I want to highlight here is that these issues are HEAVY. Really, brutally heavy, and in large part because they are invisible. We may see the symptoms of low mood, for example, in someone who is listless and emotionally numb, but we don’t see what’s causing it, as compared to a broken leg or other purely physical ailment that is very obvious and easy to respect and empathise with. This is what leads to the shitty comments and the lack of understanding, and this is why I feel increasingly inclined to share what I can about my own experience and what I’ve learned along the way. The more we can educate ourselves and each other, the more we can end the stigma and prejudice against mental health.

To whit: I have depression and have been recently diagnosed with ADD. Looking back I can identify the effects both of these have had on my life. Depression was present, sometimes fleetingly and sometimes for months, in occasional phases since my teens. I was always able to get on with life, skipping the odd day of work if I felt really rough or anxious, and managing to complete my degree through a months-long bout, which I suspect was brought on by a combination of stress and the end of a short-lived but rather tumultuous relationship.

The ADD was not a massive problem at school – one of the flipsides of the inattentive type is that, when you’re really into something, or have a tight deadline, etc, you can click into hyperfocus. This was absolutely my MO at school – I’d absorb the lessons and books for most subjects because I was interested, but homework or final projects only ever got done at the very last minute. I had a LOT of late nights and all-nighters throughout my various courses of study. I have always struggled with time management – no matter how much time I have to get ready, I’ll always end up thinking “oh, I’ll just do this before I go” and end up being late. I procrastinate like crazy – even for something I really want to do like make a drawing or learn a new song on the guitar, I will do ANYTHING except the thing I’m supposed to do, so it takes ages to settle down to a task. I’m fidgety, if not out-and-out hyperactive. In meetings or lectures, even ones I’m enjoying, I’ll shuffle in my seat, never quite getting comfortable. I doodle INCESSANTLY. In school, and in any meeting, I always had a bit of paper in front of me, slowly filling with patterns.

Like the depression, I managed it in the past (I didn’t know that my behaviour was in any way unusual, let alone treatable), but what brought both of them to a debilitating level was having kids. The physical and emotional demands of children, the lack of sleep and commensurate imbalance in biochemistry sent things a bit haywire. I also developed crushing anxiety, imagining terrible things befalling my babies, horrible accidents. I found out that these are called intrusive thoughts, and this is a kind of obsessive-compulsive disorder; you can’t help thinking about it. The more the thoughts wear a path in your neural net, the easier it is to repeat them. Very fortunately, I found I was able to manage this by being absolutely vigilant in thinking about something else – ANYTHING at all – the minute one of these thoughts popped up, and they did stop coming in time.

Trying to maintain my business was the straw (pretty huge straw in fairness) that broke the camel’s back (I’ve detailed the day I really broke in a previous post, here). This was almost exactly two years ago. The time in between has been a long experiment in trying to get better.

I started with the lifestyle changes. Going for a walk every morning, or as often as I could. Eating healthy food. Regular yoga classes. Herbal tonics. Taking extended periods of sick leave. Doing things I love; playing music or drawing or photography. Trying to sleep more. It all helped to a point, yet the big empty remained. I couldn’t persuade myself that life was worth living. With two beautiful kids, a loving husband, a house by the sea, and working in my chosen profession, my passion: I couldn’t connect with it.

A few months in, I started antidepressant medication. Again, it helped a bit, but not enough. A few months into this treatment, there came a day when I got a serious and immediate impulse to harm myself, which is something I had not experienced before, and I put down to the medication – so I came off it. Then it was summer, I didn’t have too much work on, I had time to relax with the family, and I managed without meds for a few months.

But in the autumn, a stressful work situation and who-knows-what-else put me right back in the hole. I started another kind of antidepressant, one which promotes deep sleep. There’s evidence to suggest that part of the vicious cycle of depression is to do with the negative thought loops we go over and over during the day, which the brain then tries to resolve with excessive dreaming, preventing the body from entering into deep sleep. We of course wake up exhausted and in a low mood before we’ve even got out of bed.

The sleep-therapy med helped – a lot. I felt capable, eager to get back to my work, enjoying my life again. Then it just – stopped. It took me a couple of months to realise I’d slipped back down into depression. It comes on slowly and, like the frog in the pan of water coming to the boil, you don’t realise how hot it is until the boiling water has robbed you of the energy you needed to jump out.

I found myself thinking more and more about ending my life. Not because I wanted to die; just because I couldn’t see any other way to make this awful combination of pain and numbness go away. Can you imagine? With my beautiful family around me, loving me, I felt so awful I just wanted to leave the planet. It takes my breath, almost stops my heart, to think about it now. I think of myself as one of the “lucky ones”; I know there are people who have far more to deal with; I’m at the mild end of the spectrum – but maybe I’m not. Maybe this was always a lot more serious than I let myself believe.

This time, I was more proactive. Once I realised where I was, I went straight to the doctor. I’d gotten over my prejudice about medication – I just wanted to get well. I started another different antidepressant. It helped a bit, and the side effects seemed much less pronounced than the first one I’d tried. My anxiety went completely. I was able to work again, albeit in fits and starts. I allowed myself rest days if I needed them and pottered through life in an okay-ish sort of way.

I knew something was missing, though, so a few months later I went back to the doc and we added another kind of medication, which seemed to take me up another notch, although with unpleasant side effects (this one gave me a raging appetite and made me lactate again; not ideal especially when a frequent component of post-natal depression is confusion around the changes childbearing has wrought on your body).

It’s always a few months between changing meds. Each kind of antidepressant you try – because it takes up to two months to achieve the full therapeutic effect. Then you have to decide if it’s really working, if you need a higher dose, if the side effects are bearable. Each change in dose is another couple of months to see what it does. Then, if it’s not working, it’s another couple of months to wean yourself off the medication. It is immensely slow and frustrating, but it’s the best we’ve got right now. And don’t you dare come at me with any crap off of Collective Evolution or similar, telling me CBD oil or magnesium or yoga or coffee or whatever will fix it better than the drugs that have been developed in labs and rigorously tested in large-scale studies, and observed for years in the public. These things are not perfect – I already said it – but they save lives.

The final piece of the puzzle was the ADD. I’d begun to suspect it, having seen something on social media that resonated, and knowing that a couple of family members have it. I did a bunch of online tests and aced every one (if you’re starting to think you might have it, this test might be interesting). I had been on the waiting list for a psychiatric assessment on the national health for months (I’d had a private psych assessment that lasted about ten minutes and left me 120€ poorer – and even so that’s about a third of what you’d pay in the UK – so I wasn’t going to go that road again). At the end of August I rocked up to Portimão hospital ready for, if not a fight, a decent conversation about my history and suspicions.

This business of doctors is a massive problem. There are relatively few psychiatrists and even fewer on the national health, here or in the UK. Of those, some of them are not up to date in their awareness or thinking and will fob you off with the bare minimum. This time, though, I got really lucky. A young woman doctor met me in the consulting room and we did a quick review of my depression medication, to which she made a couple of sensible tweaks. I then brought up the ADD. She was skeptical to begin with – which is fair, there are hypochondriacs in all areas – but as I listed off my behaviours and symptoms, she took me seriously and confirmed my suspicion.

The day I started taking the ADD medication, I felt better. Truly, deeply, securely better. Life came into focus, the colours seemed brighter. I felt calm and happy. I simply got on with my day, instead of wasting huge amounts of time and energy faffing and distracting myself with anything I possibly could. It’s not overstating to say it was a revelation. I haven’t suffered a single (negative) side effect. I have this feeling of “what’s the catch?!” but there really doesn’t seem to be one. And apart from that, I just feel so incredibly grateful that these things exist and that I found my way to the right doctor and course of treatment.

So what do I want to say, in conclusion? In the words of another mum blogger, Eve Canavan (see her blog here), who has been through far more drastic episodes than me, “God bless the good ship Meds and all who sail in her!” is one sentiment. But mostly I just hope this will help those dealing with issues to feel less alone, and perhaps awaken a bit of empathy and understanding in those who might not have considered what this all involves.

Thanks for reading if you got this far, feel free to share and know that I am always, ALWAYS, available for chats if you have something you’d like to talk about, however insignificant it may be. Please don’t give up. There are so many ways to support your healing from or dealing with mental health conditions, and when you find what works for you, well. It’s magic.