How are you?

One of the most difficult aspects of living in the UK is the bizarre mix of box-ticking politeness with genuine emotional reserve.

In other words, while almost everyone will ask, ‘how are you?’, the only acceptable answer is ‘fine thank you, how are you?’

Perhaps we should just invert the meaning of ‘fine’ ? (Image by DestinyBlue – a supremely talented artist specialising in cartoons and comics. The original can be found here)

On a black dog day, this presents a problem. Either you break social convention and cause widespread panic:

‘Oh, the usual mix of abject misery and thoughts of self-harm, how about you?

Or, you lie.

In the short term, lying seems like the obvious option. For one thing, it creates less paperwork. I once made the mistake of being brutally honest with a colleague about my desires to end my life. Within a few hours I was being invited (that’s the British for ‘ordered’) to have a chat with both human resources and occupational health. Oddly enough, this didn’t help me to feel any better. I just felt like a troublemaker who needed processing to avoid any awkward legal ramifications.

Unfortunately, lying isn’t necessarily the easier option. For one thing, it’s very tiring. Among other things, the lie has to be convincing, else you risk being bombarded with increasingly probing questions. More questions means more chances for the mask to fall off until – BOOM – you’re in social faux pas territory.

Someone recently asked how I was, following up quite reasonably when my reply proved unconvincing. I responded like any cool and emotionally well-adjusted person, and burst into tears. They looked terrified. I’m not sure why. I was producing gentle whimpering sounds whilst leaking salt water from my tear glands. I was not wielding an axe. And they call me the crazy one! Anyway, the point is, for the lie to work, you really have to nail that first line. Since most people aren’t fooled by words alone, this means a smile or, at least, a jolly tone is essential.

‘I’m fine thank you, how are you?’

Sound simple enough? Well it isn’t. When you’re in the clutches of depression, it requires an enormous amount of energy. Many a day I’ve gone to work, said nothing except a couple of ‘fine thank yous’ , and come home utterly exhausted. Which has a knock-on effect on my ability to do it all over again the next day.

But there’s another problem – a more insidious problem – with lying. Every time you tell someone you are ‘fine’ – when you’re not – you buy into the belief that it’s not acceptable to be depressed. In other words, the act of concealing your true mood, sends a subconscious message that it needs concealing, that it’s something to be ashamed of.

It’s a very sad indictment of our emotionally-illiterate society that those or us who are suffering the most have to hide our feelings to protect the sensibilities of everyone else. One in four of the seven billion human beings on this earth will experience poor mental health at some point in their life. That’s 1.75 billion people. And over 10 billion in the history of humankind. The only shame would be if all those people lived their lives feeling ashamed of something that is clearly such a common part of the human experience.

So what are we to do if neither lying nor the truth are realistic options? Well, one of my favourite options is the deflection. To think like a politician and answer an entirely different question.

‘Oooo, I’ve been experimenting with blogging. Although it is meant to be anonymous, so I’m afraid I can’t send you the link. Or even tell you what it’s about. You?’

I’ve also come up with an answer that I can say with a genuine sense of belief (and positivity), but which isn’t a lie,

‘I’m still here, you?’

When you’re struggling with depression, the definition of a ‘good day’ sometimes has to be set a bit more generously (Image by Allie Brosh, author of Hyperbole and a Half – one of the world’s most talented mental health bloggers. The original appeared in a post called, I’m Definitely Not Dead)

Depending on the time and the person, however, I think there is a better approach; sugar-coated honesty. To answer in a way that reflects the troubles you’re going through, that openly admits your poor mental health, but perhaps leaves out some of the grim details:

‘I’ve been struggling with poor mental health, which can make it hard to achieve much, but I’m hanging in there and I’ve just been put on some new medication, so I’m hoping that’ll help’

Not everyone will respond appropriately. Some might even say something laughably unhelpful. But the vulnerable honesty can be surprisingly empowering. And, if you’re lucky, you might even get a bit of empathy and kindness.

So, ladies, gentlemen and other black dog owners: ‘How are you today!?’

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Warning Signs

This time last year, I went to the doctor with some slightly alarming symptoms. Swollen lymph glands, fatigue, hot sweats, and unexplained weight loss. Lots of unexplained weight loss. Naturally, I’d already had a consult with Dr Google, and the prognosis wasn’t looking good. I had cancer. I was going to die. The only question was how quickly.

A consultation with Dr Google

The real doctor thankfully wasn’t quite so alarmist. But he did agree there was enough reason for concern. So he ran some tests and I waited. Two weeks later, except for a mild infection (explaining my lymph glands) I had a clean bill of health.

‘So what’s wrong with me doc?’

‘Stress’

My heart sank.

Not because I wanted cancer (my sanity had not yet completely flown the nest) but because I knew exactly what it meant to be diagnosed with stress.

For starters: very little in the way of treatment. On at least one occasion, I recall my doctor advising that I ‘try to relax’. If I’d been in a more argumentative mood, I’d have challenged him on the evidence base. I don’t know about anyone else, but I don’t find that being told to relax actually helps me to, well, relax. ‘Perhaps try some breathing exercises, or relaxation techniques?’. Oh, good idea doc, I hadn’t thought of that. Treatment administered. Patient cured. Next!

Once you’re in the outside world, a diagnosis of stress also brings other problems. Tell someone you have a serious physical illness, like cancer, and you can usually expect some degree of concern and empathy. Tell someone you’re struggling with stress, and you’re lucky if they don’t just say, ‘join the club’.

There’s a shred of logic to it; cancer is painful, life threatening, and the treatment can be horrendous. In contrast, most people view stress as little more than a minor irritation; an inevitable consequence of modern life.

Except stress can be very destructive, especially when you are exposed to it for a medium to long time. I only have to look at my own experience to realise that.

Five years ago, I had a series of increasingly embarrassing investigations, to find out the causes of my ‘fun bum and tum’. Well, that’s what I call it. It’s not actually fun. A better description would be my ‘very unpleasant and inconvenient disorder of the digestive system‘. But that isn’t quite so pithy. Also, I find a little bit of sarcasm and self mockery can be empowering. Anyway, the symptoms (which are now a permanent part of my life) are constant (sometimes severe) abdominal pain, constant (sometimes severe) nausea and unpredictable (sometimes extremely inconvenient), erm, ‘toiletry habits’ (that’s British for ‘I shit funny’, by the way). When I first developed the symptoms, Dr Google suggested I had either had bowel cancer or inflammatory bowel disease. But all the tests came back clear.

‘So what’s wrong with me doc?’

‘Stress’

Four years later, and I was in A&E having an ECG. I’d been experiencing irregular, and painful, heart beats, dizziness, lightheadedness, cold sweats, and a’ ghostly complexion’; or so people would remark. Yet my heart was fine.

‘So what’s wrong with me doc?’

‘Stress’

A mild irritation, a part of modern life. Yet, in just one person, it was causing palpitations, dizziness, lightheadedness, shaking, limb tingling, cold sweats, hot sweats, abdominal pain, headaches, dry mouth, nausea, weight loss, and fatigue. No wonder stress is shown to shorten your lifespan, and precede depression.

Stress can do surprising things

It’s easy to say that my eventual slide in severe depression was inevitable, given what I was living with physically. But the problem wasn’t as much the state of my body, as the fact that I wasn’t listening to it. For months, perhaps even years, I was ignoring an environment and a set of circumstances that were causing significant stress. With each additional symptom, my body was begging me to change. Warning that if things didn’t change, a crisis would come.

In fact, stress doesn’t just precede depression, it actively prepares our brain for it. Perhaps, in this context, depression can almost be seen as a defence mechanism; the body’s way of slamming on the brakes when it can’t keep going?

Regardless, all that matters is this: don’t ignore stress. Don’t ignore your body. And don’t trivialise. If someone tells you they are stressed: empathise with them, listen to them. They may not know it, but somewhere inside, their body is warning, ‘if things don’t change, a crisis will come’.

 

UPDATE (15-May-2014): I have had to disable comments for this post due to a relentless bombardment of spam 😦

From Crisis to Clarity

“Never let a good crisis go to waste”

So Winston Churchill and, more recently, Raum Emanuel are credited for saying. It’s a simple, if cynical idea: When things get really bad and the people get really angry, it presents an opportunity to make some really radical changes.

If you can take away the taint of politics, I think this mantra actually holds some real truth and wisdom.

When we go through personal crises, we send ourselves, and those around us, a very clear message that something is wrong and has to change. We might have spent months, years, or even decades, coping with (or ignoring) a very damaging or harmful situation. That moment when our resistance finally breaks, when the crisis takes over, is when our inner-self finally shouts out, ‘enough is enough!

So it’s an opportunity. Albeit one I hope no-one ever has to experience, because crises, especially mental health crises, are horrendous. Miserable. Terrifying. Life-threatening. 1 in 10 people with major depressive disorder eventually end up taking their life. I suspect most of those tragedies happen during a crisis. In this context, calling it an ‘opportunity’ seems both glib and callous. Like when those annoying cheerful people say, “Remember: what doesn’t kill you only makes you stronger!“. Aside from the cold Darwinian truism, this ignores the very real and exhausting daily battle for survival that defines a mental health crisis.

The eye of the hurricane

I’m talking about crises because I wanted to share my story. And, for some reason, it doesn’t feel like it starts when I was unintentionally conceived. Nor during my early months, trying to bond with a mother with post-natal depression. The psychoanalysts will clearly disagree, but from a narrative perspective – at least – I feel like my story actually starts near the end. Last summer to be precise. When I was in crisis.

It seems weird looking back. Not in an ethereal / spiritual sort of way, but in a, ‘what a nutcase!’ one.

I remember sitting on the sofa, looking outside at the sunshine. It had been a fantastic summer – weather-wise – but that just made me more envious of all those other people – the ‘normal’ people – who could enjoy it.

In fact, I was finding it hard simply to go outside, never mind enjoy myself. I’d become quite fearful of being seen by people. I’m not sure why. In a modern city, you can walk down the street dressed as a zebra and few people will look up from their smartphones long enough to care. Maybe that was the problem? The invisibility? More likely it was because I’d been signed off work. And when you’re off sick you’re supposed to stay inside feeling miserable. Well, that’s what Society expects. Even for a condition where spending time with nought but your thoughts can be lethal.

And, ouch, were those thoughts cruel. So cruel, that I’m reluctant to repeat them here, for fear of moving the tone from mildly melancholic to soul-sappingly desolate. Suffice it to say, I really hated myself. When I looked in the mirror? Disgust. When tried to focus on my achievements? Derision. When tried to think about my value to others? Disdain.

So I sat, and I stared blankly at the sunshine. Broken and utterly defeated.

I’d been battling with my black dog for so long. I was on a psychiatric dose of my antidepressants. I was on waiting lists to see psychologists and psychiatrists. I was reading self-guilt – sorry, self-help – books. I had even tried running. Lots of running. But despite it all, I was only getting worse. I’d stopped crying. I didn’t even want to hurt myself anymore. I was just a shell, wanting and waiting for it all to end.

And it did. But not in the way I had expected. For a long while I’d been gripped by fear. That I’d lose my job. That I’d lost my friends. That I wouldn’t be able to support my partner or pay the bills. But as my grasp on reality finally gave way, they stopped being worries and became fact. I had lost everything. And I was just a man, sat on a sofa, looking at the sun.

Whether this was really my moment of crisis or actually my moment of clarity is open to debate. I like to view it as the eye of the storm. Once I had total belief in my paranoid fears, I actually found a glimpse of freedom. So I went outside, felt the warmth and glow of the sun, and thought, ‘for the end of the world, this is surprisingly pleasant’.

Hindsight (and further reading) reveals that I’d actually stumbled upon a classic self help devise. I had disarmed my fears not by avoiding them, but by fully exploring (and in my case, totally realising) them. Which makes me one of the lucky ones. Most of the rest of my crises had been defined by chaotic, impulsive, and occasionally rather scary thoughts and behaviours. But in that moment, when I entered the eye of the storm, I found clarity.