Today I made what I think was a brave decision. I called in sick and was honest as to why. Writing this is my antidepresssant.
For the last 20 years I have described myself as a 'former' mental health service user, or as having ‘recovered’ from my mental health problems. I am wondering whether that is true.
Over the last year, in my newish job, I have found things tough. And, to be honest, prior to that too. I have had bouts of anxiety, stress, and (yes, David, say it) depression.
I know the difference between mental (yes, David, say it) illness and this anxiety state. The former had me incarcerated and suicidal for six years a long time ago. This is very different. But the mental patterns are similar.
I do not want to wallow in melodrama, though I am rather good at that. And, I do not want the anxious concern of others (though a little reassurance goes a long way). But maybe I should admit it – I am suffering from anxiety, mild to moderate depression, and a form of mental habitual thinking that is less than helpful! Maybe I am a bit ill. After all, I am not Superman, and it is a bit of a relief to admit that.
Many years ago
When I was very ill, I had what I called ‘loops’ of obsessive thinking. I would see something, a flower, say, and then obsess about my thinking about it. The pattern went: There’s a flower. Oh, I am thinking about the flower. Oh, I am not really seeing the flower. Oh, I am observing me thinking about the flower. Oh god, I’m thinking like this again. Oh shit, I’m still ill. Oh, f()<k, why not kill myself?
The escalation happened in a fraction of a second. Every day, all day. Living through this machine gun firing of neuronal impulses meant constant pain and sapped my mental and emotional energy. It kept me focused on my internal workings and meant I missed out on external life. Underneath this ‘wired’ state was a depressive exhaustion. In retrospect, I think I had some sort of OCD, without the ‘acting out’.
I had hoped that the mental patterns that led to this profound distress had burned themselves out, and that the rewiring during recovery had left me with lifelong ease. I am fortunate that the volume has been turned down significantly, and that the anguish dissipated. Many are not so lucky. But lifelong ease? No such luck.
These days, the anxiety patterns still occur during times of stress. I obsess about a problem, and it becomes a vague visual or sensory image floating near the back or front of my mind (just behind the eyes in fact). I will think about something else, but like a rubber band, my mind (usually accompanied by a subtle eye movement and associated gut pull) will pull back to the ‘image’ or ‘feeling’.
The work to be done is to be mindful, to breathe, to come back into my body. Relaxing my eyes can help. But at times of more intense stress, such as the last four to five weeks, this continual mental work becomes exhausting.
On top of this mental pattern, I can then make up stories – fleeting, powerful, negative stories. These ‘judgements’ are the killer. Whereas my former patterns led me to say ‘I want to kill myself’, these sneak up and like the devil on your shoulder, say things like ‘there, you see, you are not good enough’, ‘you’re weak’, etc. But they are so so subtle, you can miss them and the words permeate or create the emotions and bring on a heavy sense of ill-being that tugs at the gut. Cognitive Behavioural Therapy ain’t going to crack it. Been there, done that…
No amount of mental coaxing from outsiders, let alone the trashy euphemisms spouted by the well-wired on social media, will crack it. All you can do sometimes is come back to the oldies but goldies – straightforward behaviourism… ‘this too shall pass’, ‘you are stronger than you think’, ‘one step at a time’.
And, of course, the help from friends. Today, I want to thank Annie Laverty and Chloe Stewart in particular for their listening, gentle support and encouragement. And, most importantly the advice I am so damn good at doling out to others - be gentle and look after yourself.
When I was recovering, I found myself doing more, but still feeling like shit. This was a vulnerable time. Others noted an improvement in form. I would be reading more, taking part in more conversations, able to go out for half an hour… but I would moan ‘but if I am doing more and still feeling like rubbish, then what is the point of living? If there is no gratification, then why bother?’.
My mind was fooling itself on an altogether different level. It was telling me stories that were based on an assumption (a) that one had to be happy clappy to live properly – this is Hollywood bullshit (b) that things won’t change, that this state of mind will last forever – depressive bullshit. What a double whammy from the lands of optimistic and pessimistic fantasy respectively!
Eventually – and this was the biggest lesson – and one I am leaning on as I write this, the more positive feelings catch up on the behaviours. But boy it is hard to believe it as the mind clings on to its habitual ‘truths’ grounded in the familiar neuronal circuitry.
Breaking any habit is the hardest thing in the world. Breaking emotional patterns may be the hardest of the hard. If you are still with me up to this point, you know this truth. If you know this truth, I am sorry. It means you have hurt a lot and have learned the hard way. I wish there was an easier path.
My mum used to say I thought too much. She was right. But that did not help. For those of us who suffer distressing mental patterns, the ‘choice’ to think differently is not always available. We are wired from an early age.
I think that mental anguish is particularly painful. I am not saying it is worse than physical pain. But with physical pain, one’s mind forms a relationship to the body’s suffering. It can soothe (though I also recognise that severe pain can lead to distorted thinking, and vice-versa). But with mental pain, the observer and the observed; the interpretive, critical and judging mind and the suffering mind become entangled; both are off-kilter, leading to ever more vicious spirals of distorted thinking and dramatic interpretations.
Another way through for me is to talk to others, to seek help and advice (though not too much – that way lies potential confusion from too much advice). And to write, to see the words. Hence this blog. In particular to get things ‘in perspective.
A pile of stuff
If someone else were to say to me that they had been going through the following list of stresses, I would be kind and say ‘that’s quite a lot, take care of yourself, be gentle’. But we are not our own best friends!
• New job, new role, a level of responsibility never before encountered, within a NHS that is struggling, in a service that is trying to transform things, in an organisation that is trying to model a different culture.
• Travelling a lot – being away three or four days a week for the last six weeks. As I grow older, I need to recognise that it takes me a while to get back my energy. And I have been depleted. I sometimes feel disconnected from my colleagues and work place. This leads to made up stories in my head that I don’t belong, am not supported, and other tosh.
• Not sleeping – a killer for me! The anxiety about sleep as every insomniac knows, becomes a vicious cycle.
• Difficult, new and seemingly relentless problems to solve at work that have added to the uncertainty and confusion (this for someone who finds it hard to deal with ambiguity and to trust that things will work out).
• A mid-life crisis – or, shall we say, things changing at home (kids growing up, changes in how often you are at home meaning a need to shift routines).
• Shall we add world events? I don’t think we should underestimate the impact of 2016 – it’s been bloody awful, and we should be shaken and worried about the state of things. A feverish and often nasty social media dialogue surely don’t help. I also think I am growing tired of healthcare work, and maybe I am not cut out for it any more – or at least am questioning whether what I do is worthwhile…
That last one is interesting. That is the bridge to another set of stories which, if I was listening to someone else, would trigger the alarm on the bullshit detector. It is a small, but profound leap, from the list of stuff I am dealing with (reality) to that additional story or interpretation that I am somehow not ‘worthwhile’. And that is a crucial distinction to make. But in my tiredness, it is so easy to sleepwalk over that bridge and find myself in la-la land.
I am grateful to Annie Laverty who phoned this morning and listened to the ‘pile of stuff’ I was dealing with, and told me to write it down. This helps.
One final thought – I am wondering how the above will affect perceptions of me, professionally and personally. I have written previously on vulnerability and leadership and whether a director should be able to ‘cry in the toilet’. I am all for declaring uncertainty and vulnerability, and ‘being who you are’.
All the same, to admit to this publicly in a high pressure job (or in any walk of life I suppose) is a risk. But I am not sure if there is an alternative if we want to tackle stigma. It might be easier if I had a bad cold.
I could have phoned in today without the anxiety about the anxiety, and then the guilt and the worry about what they think… but I chose to tell my colleagues. I hope that was the correct decision.