Mental health and me

August 31, 2015

I've been doing this all wrong. Whenever I write about a topic I care about, I turn to statistics to back up my feelings and help people understand why they should care too. It doesn't work well. In this article I will share my personal experiences to convey the importance of mental health.

Mental health disorders have affected me and the people I care about most. It's something I have only talked about with a few people, but I feel like we all need to discuss these issues more openly. I'm going to talk about my experiences of mental health and my understanding of how important these issues and their treatment are today.

I'll split this article into four parts so you can find what you're looking for, and avoid what may be triggering:

The first section covers my experience of depression and anxiety. The second covers the idea that you're not alone when suffering with mental illness. The third section discusses what starting to get help is like with some of my thoughts and some from my friend. And the final section is on help, advice and what you can do.

If you have any questions or suggestions, tweet me @gmph.

My Experience of Depression and Anxiety

When I talk to new people one of the things I now commonly ask is if they have experienced any mental health issues and if they are happy. These questions – which are rooted in being a way for me to try to learn how to be happy myself and how to understand how I was feeling when affected by depression or anxiety – are now a routine part of me getting to know new people. I ask these questions because I understand (at least a little) what it is like to have an issue you feel like you can't talk about. I want to play my own small role in normalising discussion about them.

My own experience of mental health problems aren't something I can define easily, nor even something I understand well myself. Before I start, I would like to say that my conditions aren't nearly as difficult to live with as many others' and I have no major concerns about my physical health due to them currently. As much as I intend to keep this positive and helpful, I feel like some expression of my own experience is needed.

Being depressed is like being trapped in your own head and not being able to control your thoughts or your mood. I usually always keep some idea of how to make myself feel better in the back of my mind: being with people, having a shower or being outside and walking. I don't lose the knowledge that those things can help.

What I do lose is all positivity, energy and willpower I have to do them. Every thought in your head turns against you: when someone tries to talk to you, you feel like you are wasting their time; when you consider doing something to take your mind off it you feel like it won't help at all, like you can never escape. Usually you end up hiding away on your own as you're mostly concerned about other people seeing that you're upset, and that (since there's nothing they can do) you might upset them too.

For me, this along with some combination of anxiety meant that often while I was at university over the past year I wouldn't go out, even as far as the shared areas in my own flat outside my room. It's not something I ever want to experience again, though I know I will. Earlier in my life, I think these issues culminated in me being anxious around people, even my friends, and very self-conscious. Many people can empathise with the feeling of being scared to talk in front of people for presentations in school – this is what it was like for me most of the time, whenever I wanted to speak. I'd think through what I wanted to say, making a little speech in my head, then often by the time I'd prepared myself the conversation had moved on leaving me to worry about my lack of input in silence.

Being scared to speak in person caused me to turn to messaging people online, which I found much easier. It let me discuss things I was worried about, but the lack of a personal closeness in these friendships in many cases caused them to end, apart from the few I trust dearly to this day. I think generally being able to talk to people online was helpful for me (especially since it was these people who helped me realise that I may be depressed in the first place), but there's also the downside of not being able to meet people regularly, which affected me.

Overall the effect of depression and anxiety on me wasn't very obvious outwardly. Most of the people in my life wouldn't have noticed anything was wrong had I not mentioned it to them, and I wasn't even struggling to hide it. It's just something I adopted naturally in order to avoid feeling judged (which my condition would have emphasised). This was a factor that I now realise was important for me to change in order to start feeling better.

You're Not Alone, and Here's Why

It is my understanding that with mine and many mental health issues, you feel alone. It is the horrible irony of mental illness that so many people suffer with them feeling like they're the only one in their position and that no one understands. But you aren't. You aren't alone.

Throughout my life I have always been quiet, reserved and withdrawn, even with my friends. I never really talked about how I felt as I considered it to be normal for everyone. For example, I cried quite often and assumed every one did secretly; I felt sick and uncomfortable in busy, crowded, social places and thought other people felt the same and just hid it better. This persisted until last year when I started university. In the few months prior to starting university I was beginning to realise that what I thought was normal might not be. The long periods of feeling down for no reason, and feeling anxious in most social situations even with friends and family, couldn't be normal. I started to talk about it. I had been interested in mental health and psychology before this realisation about myself. Several people close to me have had experiences with mental illness and my attempts to learn more about it to support them left me knowing what I should do (though it was far from easy when I actually had to put this into practice).

I tried to talk to people about how I was feeling and over time found a few people who I could trust. I won't go into too much detail here, but the people I came to trust were in similar positions to me. They could understand how I felt, and I could understand them too. It surprised me how little was needed to achieve this level of trust. Just a common problem and understanding of how we felt was all that seemed to matter. I'm not so sure that was it though. While, yes, we did understand each other, that's not what I needed when talking to people and that's not all I needed to give.

The friends I made and the people I talked to at university are special simply because they were accepting. Oh, you've been crying for the past three hours? That's okay, I'm here, call me, or meet me tomorrow maybe? Don't have the energy to get food tonight? I'll make some pizza. And here's some Ben and Jerry's. It's these small things that made these people so important to me. We accepted our situations and did the best we could to be happy and support each other. I tried to say it as much as possible but I really can't thank my friends enough for the help they gave me.

This experience is really what made me realise that I'm not alone. I had talked to people online before in a similar way to this, and some have become my good friends. This extra step of finding friends in person who could talk about mental health openly, affectionately and understandingly was a big help for me. No matter how you feel, you're not alone. There are people there who you can talk to and sometimes you just have to open up, spill your feelings, and you'll find them.

The important thing to take away from this story is that mental health is something which affects everyone. You don't have to have a severe condition to be one of the people who can support someone: you just need to listen, be accepting and talk to them. There's no magic answer to mental illness and everyone will find that different things help them, but we can all appreciate some genuine affection sometimes. From my experience, if you are accepting, you'll find the rest follows.

What Starting to Get Help is Like

Having friends to support me was extremely important. It was something that I didn't take advantage of or notice I had for a long time and I should have. It gives you a solid foundation of support to start from to seek further help. One thing I have experienced is that even when I know what to do, what the next step to getting better is, it's significantly more difficult to see it when you're in the situation yourself. You need support to see what to do.

The first thing I did to get help after talking to friends (and before discussing it with my family) was to contact my university's counselling service. They sent me a couple of forms which I filled out and sent back to them. Then they told me to go along next Tuesday at 2pm. I did. I had no idea where I was going, which was fun. I had been in the university library a few times but never on the floor of the counselling service. Once I found it, after a short detour past some computers, through a wrong door and along a corridor quietly trying to make sure no one heard or saw me, I found it. I was given a short survey to help them understand how I was feeling and then met one of the counsellors.

We went into her office and I sat down. She told me to get out of her seat (politely). After shuffling around to take an acceptable seat I began a long, unstructured rambling of my feelings. There was a lot I had to discuss and being able to talk to someone for a short while was nice, and not having to worry about her not wanting to listen or help was nice too. No matter how well I thought I knew myself and my feelings, counselling helped guide our discussions and helped me understand new things I should consider.

For me, counselling was a way to talk through the difficulties that were upsetting me that I couldn't figure out on my own. It was a way to come to decisions about several things which worried me at the time. While it did help to remove these stresses from my life, it didn't help with how I was feeling in general due to depression and anxiety. The counselling I received was just like talking therapy rather than a full course of CBT. Counselling works for many people with many different conditions, though in my particular case it wasn't the full answer.

The other help I sought was from my doctor – once at university and once at home. I have never been diagnosed with any mental health condition officially, which may seem odd given that I've described my experience of having and anxiety and clinical depression. This little contradiction leads me to a story.

After spending the majority of a year at university going through the motions and trying to keep my mood higher than it wanted to be; after a period of sneaking into the school library on a weekly basis trying not to be seen, sitting nervously in counselling sessions; after several weeks of completely avoiding my studies and socialising to attempt to focus on being happy; after several tense conversations with my parents and trying to stop them from worrying: I came home from university for a short break and went to see my doctor.

Sitting in the small, local practice's waiting room, looking around anxiously, I was scared but glad I had taken this step. I was called in. The doctor – a middle-aged man, bald with thin-rimmed glasses which made him look like a philosopher – asked me to sit down. I did (in the correct seat on this occasion). He asked why I was there and, abruptly realising I would actually have to explain everything I was feeling, I said “I think I have depression,” then waited for his response. After some further discussion of how I was feeling and what had happened at university, and him giving me some useful things to read, I needed more clarification. Throughout the appointment he had been careful to phrase things like “if you feel like this” or “if you think you have X then Y might help”, without giving any diagnosis. I felt that a professional analysis of what I was experiencing (some firm words validating my concern) would help me to both come to terms with it and encourage me to continue to deal with it. The doctor was reluctant.

One thing he said gave me hope that I wasn't just being a hormonal, upset teenager. He explained that he was worried about writing in my medical notes that I have depression and anxiety (while casually confirming my suspicions). He explained, with a look of cloaked embarrassment, genuine empathy and intelligence, that if he entered these details in my notes I wouldn't be able to receive reasoned care in the future unless I wanted medication. “In the 8 minutes a GP has to treat you,” he explained, “if they see a mental health condition and similar symptoms they will prescribe pills.” While this can work for some people, a tailored and thought-out, case-by-case approach is better and not afforded by the current system. Some people respond well to medicine, some to CBT, some to therapy, some to counselling. My doctor was scared that I wouldn't be treated properly by other doctors in the future and so didn't want to diagnose me officially.

To me this signifies that mental health isn't discussed openly enough in society in general, and even by those in charge of health services – the people we rely on when seeking help. Every piece of advice out there suggests that when you talk to someone with a mental health condition who is ready to be helped, you should help them feel confident enough to talk to their family or close friends, then their doctor. When that important professional step isn't functioning as it should for people who aren't ready for medication or don't necessarily need it, when doctors are too scared to make a diagnosis because of how that patient will be treated in the future, there needs to be improvement.

In this meeting, my doctor did everything he could to help me and discussed both the issues I was having and the psychology related to them in good detail. He suggested many ways that I could help myself and I left feeling happy with our discussion. However, one of the main things I took away from my appointment was that the system he was working in was not adequately set up to provide help to people with common mental health conditions of a similar level to mine.

This story aside, there is lots of help available for conditions of all severities. While taking the first steps to get help is the most difficult, it is also the most important thing you can do to help yourself. There are people far more experienced than me in the process of seeking help, getting treatment and recovering from mental health disorders, but I can share a few thoughts on getting help.

My own attempts to overcome depression and anxiety are still ongoing so, apart from saying that I am currently considering medication, this is where my input to this section ends. I have asked a few friends who have experience of medication and the next steps in seeking treatment about their experiences; I'll share some of what they said below.

My friends have had mixed experiences with medication. The majority of my friends have found that medication has helped their conditions (as do most people in the general population). There are some common issues I've seen when it comes to medication though. The first is that it's important to have a good relationship with your doctor and take time to have them explain things to you, including possible complications and side effects. It's important that you and people close to you know these so that if anything happens you can do something about it. Read up on symptoms and you'll be well prepared to deal with them if something happens. As the full descriptions of side effects can be rather overwhelming, it's also good to ask your doctor about which specific ones you're likely to experience, if any. Once you know these, and as long as you take your medication as prescribed, there are very few cons to trying medication.

My friends have switched medication several times, as advised by their doctors. This is part of the process of finding the most effective combination of treatment and activities in their lives to be happy and less affected by their mental health conditions. Some changes work, others don't. Medication isn't a complete solution in many cases but can pick up your levels of happiness in the case of depression, or ease your mood, or help to reduce the effects of other symptoms of mental health conditions. It can make living your life easier so that you can take steps to be more healthy in general and do additional things to feel better.

As for medication, therapy and counselling is also effective for many people. If medication isn't for you, then trying therapy may be a good step. Therapy is extremely effective, especially in young people, but does require patience and co-operation too. Waiting lists for therapy can be quite long, but if you can arrange to be on one I would recommend that you do. People I know well have been helped greatly by therapy.

If medication and therapy are both large steps for you, there are always simpler things which can help: ensuring you get a good amount of sleep, spending time outside regularly, exercising and eating healthily. Additionally, there are CBT courses available online that anyone can use for free. One course called MoodGYM was recommended to me by my doctor. Other sites like 7 Cups of Tea let you talk through your issues anonymously with someone online. (You can also sign up to talk to people and help on 7 Cups by taking a short 'active listening' course, which I'd recommend.) I have used both of these and found them useful. If you're looking for something to try, these links are a good place to start; after that keep googling and trying things until you're feeling better or are ready to take further steps.

I hope that gives you a good idea of the whole experience of seeking help. It goes through stages: beginning to notice a problem; talking about it with others and understanding it more; talking to a professional like a doctor or counsellor; seeking treatment; finding one that works for you; sticking to it until you notice an improvement or try another.

Help, Advice and What You Can Do

Everyone's experiences of mental illness and treatment will be different and everyone's path to recovery will be different. There's no one-size-fits-all solution to hand out, but there is a general set of stages that I have seen people (including myself) go through:

Recognise that you need help
Discuss your feelings with others
Speak to your doctor about treatment
Find a treatment that works for you
Keep going

Knowing these steps gives me hope that (while I might have some way to go) there's a definite path for me to follow and an easy set of things I can do. Even when I don't feel positive about the way things are going, it brings some order back to what doesn't feel like a very ordered or consistent experience.

Recognise that you need help.

Recognising that you might have a mental health problem isn't as easy as you might think. It takes some understanding of the various conditions and an accurate idea of what being healthy is. Understanding mental health and the psychology of it (to a basic level) is something I would encourage everyone to do as you will likely have to deal with it yourself at some point in your life, and right now there are people in your life who will be going through issues with their mental health, so putting in some time to understand will help them a lot and let you support them if you would like to. One of the most obvious resources on mental health is the NHS's Mental Health pages, which include short overviews and in-depth details and advice. These can help you understand the basics of common mental illnesses.

Once you have an understanding of mental health in general, thinking about how you feel is the next step. Sitting down and taking some time to yourself to think over how you have been feeling may work for you, but sometimes when you try to remember past feelings you can miss important factors; for example, brushing off the lows of depression as simply being upset because you can't quite remember the intensity of it, or not being able to see the cycles of highs and lows of bipolar disorder as you go through them. A good way to get an accurate representation is to keep a brief diary of your mood (the positive and negatives) and see how you're doing over a period of two weeks. The NHS also provides self-assessment quizzes to give you a better idea of what to look out for, which works well with a diary.

Discuss your feelings with others.

If you realise something might be wrong, then the best thing to do is to talk to people you trust about it. This can be easy or difficult depending on how you feel about the people around you but there is always someone you can talk to. You might be able to talk to close friends or family members. If you feel that's too much for you, you could speak to one of the many organisations set up for exactly this purpose without even giving your name. You can find a list of these helpful organisations on this NHS page. Even if you feel hopeless about your life, there are people who care and want to help; try to open up whenever you can and reach out to people.

Once you've found someone you trust, you can talk through your feelings and any worries you might have. This release can be good for relieving some of the stress of knowing you have a mental illness or just some of the negativity you're feeling because of it. It also lets you talk through the options you have for seeking help, getting better and moving on to the next step.

Speak to your doctor about treatment.

Talking to a professional about mental health will never be easy, but it's an important step in the process of finding a treatment that works for you and improving how you feel. Finding the right professional to talk to is also really important. Personally I would recommend going to your GP to discuss things, and being ready to organise a few appointments before you can come to a decision about treatment. The best thing you can do is prepare and understand the various treatments that may be available before you go in and ask the doctor about all of them. For example, a doctor may think medication is right for you but you may not be ready for that step yet, or they may suggest self-help when you would prefer to talk to a counsellor and try cognitive behavioural therapy (CBT). By being aware of the treatments available and what you think it best suited to you, you will help the doctor find what's right for you with their professional input to guide you. This will also help you avoid the issue I had with my doctor and allow you to be confident with them.

If you don't want to take the step to seeing your doctor immediately (perhaps if you're young, or not confident seeing your doctor), there are other professionals you can talk to. In the UK, schools, colleges, universities and workplaces usually offer counselling services, and this is the same in many countries. These services provide a great way to talk to someone confidentially about the details of any problems you might have. Often they will be able to help you and talk through possible options with you, or help you contact someone else who can help, including a doctor regarding medication.

Find a treatment that works for you.

Once you have spoken with your doctor, a counsellor or another professional, you can start to try treatments for the problems you're experiencing. These vary from person-to-person and per-condition but some of the common ones are medication, counselling, psychotherapy, group therapy, CBT, creative therapy and hypnotherapy. This isn't an exhaustive list so the best way to find out what might help you is to discuss the options with your doctor after researching them yourself. Choosing a treatment can be scary as it's the stage where you have to admit to yourself completely that you need help but that's okay. Take your time with it. The important thing to remember is that you have people to talk to and people to support you. It might be good to discuss the options your doctor gives you with friends or family before going back with a decision, or even to take someone you trust with you to an appointment with your doctor.

The first treatment you decide to try might not work for you so if you feel like you need to try something else after giving your first option a good chance to work, talk to your family and see your doctor again. Keep trying to go through this cycle of support until you find something that works well for you. Your doctor is your best friend with this.

Keep going.

When you've found a treatment that works well for your condition, just keep going. Don't give up on it and try to understand that there may still be ups and downs while you're being treated, and that you may need to keep using your method to control how you feel in the long-term. I have included this step because finding a treatment that works for you isn't the end, you have to keep putting the effort in and focussing on being healthy and happy. Relapsing and having unexpected breaks from your treatment are also a normal part of recovery so it's okay if things break down and stop working. You know what you're doing and have done it before, so you just get back into your cycle and do everything you can to talk with people you trust about how you feel, speak to your doctor and seek treatment again.

You can also make small changes in your life to make living with your condition and making sure your treatment is working easier. These can be small things like going for a walk every day or exercising or doing something you enjoy (for me taking photos) or even larger things in the structure of your life that you feel will make things easier for you. For example, I made a big change in my life by choosing to leave university and work instead. It's something which I knew would make me happier and thankfully I found an extremely interesting job that keeps me creatively fulfilled and is more than flexible enough to allow me to adapt if I'm feeling down. This change I made is one of the biggest things I have done in my life (finally straying off the standard path of school, high school, university, then work) and it has helped immensely. Considering some big changes may help you and focussing on being happy and healthy (especially with your mental health) is something I'd recommend that you hold above all else.

While these steps are simple, following them isn't. Here are some things I found helped me keep going.

As simple as these steps may seem, anyone dealing with a mental health issue will understand how difficult it is to get from one to the next. In the steps above there are things which I have struggled to do and am currently struggling to do, but I know there are things I can do to help myself.

One of the best things to do is to find some small things that make you happy. Personally, I enjoy being creative, so photography, playing ukulele and singing are the things I usually turn to if I feel down. Even smaller, simpler things can help too though. An important fact to remember is that changing your environment by going for a walk or taking a shower or even going to a different room can have a large impact on your mood. I find that being with people in a relaxed environment also helps. Having these little things to turn to can help distract you and help you control your mood at any stage of the process.

Another important aid to help you progress is to have someone you can talk to in detail about how you feel and what you want to achieve. This person can encourage you to keep going and remind you of what you could do next, while still not taking the load of your worries onto them. This is the most helpful thing when you're trying to get better – everyone needs support and finding someone that understands and can help you is key, whether that's a close friend, family member or someone else you trust.

The simple truth about mental health is that is can be a very lonely experience. The one thing that you can do that will help – the line you need to cross to start getting better and manage your mental health issue – is to talk. There are always people you can talk to. No matter how low you feel you can reach out to them. Trust the people in your life and ask for help, and with time you will see that things get better.

Acknowledgements

I'd like to say thanks to the many people I have discussed this article with for their advice and input. Speaking to people about the issues in this article gave me even more encouragement to write it as I know the issues are important to them.

Please also know that I am not a doctor or medical professional and the advice I have given is generally me passing on advice given to me, or based on my own personal experiences. Please talk to your doctor for sound advice.

If you have anything you'd like to add, suggest or correct, please tweet me at @gmph, or email me at hi@grahammacphee.com. If you have an experience of mental health to share (especially if it's different to what's above) then please let me know and I'll add it if it will be helpful for people. You can also get in touch if you need someone to talk to about any personal worries you may have.

Thank you for reading this article. Please share it with anyone you think it might help.