Wonderfully, this year’s Mental Health Awareness week coincides with the start of my exam season. The exam period is to mental health what January is to physical health, but instead of a barrage of flu strains, hangovers and chocolate overdoses, the onslaught consists of sleep deprivation and intense pressure to succeed, all within the shadow of ‘your future’, which for four weeks appears to depend solely on how quickly you can scribble down an essay.
Last year, exams pushed me dangerously close to the precipice of a relapse. A return to therapy and an unpleasant few weeks dragged me back to normality, but the wobble made me very aware of how complex my mental health is. While I had predicted heighten anxiety, and possibly a quick spell in the fog of depression, I hadn’t anticipate such a full-throttle resurgence of some anorexic tendencies. This unpredictability defines many people’s experience of mental health conditions and can make everyday life difficult. Someone suffering from generalised anxiety disorder may predict that an exam or job interview would trigger heightened anxiety and they could therefore take steps to manage the situation. However, sometimes the heightened anxiety is present from the moment the person wakes up, with no obvious trigger, making preventative steps practically impossible.
Over the last few years, attitudes towards mental health have changed markedly, and the taboo is lifting. But while some conditions – such as depression and anxiety – are increasingly escaping the stigma, other mental health conditions are still discussed in hush tones, or simply not mentioned at all. Over the last year, greater attention has been paid to the prevalence of self harm and eating disorders among children and young adults, and advocates such as Bryony Gordon and the Channel 4 comedy Pure have been instrumental in increasing understanding of obsessive compulsive disorder (OCD). But other conditions – such as the other nine diagnosable personality disorders – are yet to be acknowledged and accepted in public discourse.
Mental health awareness is still in its early days, so it is unsurprising that there is a level of universalisation and simplicity that is not always helpful. Triggers are seen as linear – stressful situations trigger anxiety, sadness can spiral into depression and social media pressure triggers eating disorders. Logic follows that if you can avoid these triggers, you can avoid poor mental health. But triggers are individual to the person. Social media is not a huge trigger for me, whereas the possibility of failure is a big old issue which I still struggle with. Stress can trigger depression and sadness can trigger anxiety; usually there is a knot of triggers that are almost impossible to separate. Some conditions do not have triggers – schizophrenia is thought to have a strong genetic element, and people who have body dysmorphic disorder (BDD) are more likely to have another mental health condition such as OCD or generalised anxiety disorder.
This simplification of triggers is also present in attitudes to treatment. Self care is frequently advocated as a way of ensuring everything is hunky dory in the mental health department, while drugs are demonised as a last resort, a temporary measure. I don’t mean to be dismissive of self care. At my worst, self care was cleaning my teeth and getting out of bed; usually, self care is eating my vegetables and an early night. I value self care hugely, but it is not treatment. My treatment is cognitive behavioural therapy (CBT), and taking my anti-depressants. And within my CBT sessions, maybe 5% is discussing my body image and social media; they are unhelpful, but they are not major triggers for a decline in my mental health. Exercise is a fantastic form of self-care, but as someone who has danced around exercise addiction, it is not always suitable. Baking a cake may be therapeutic but it is not always healthy to demolish the whole thing or aggressively feed it to others while not eating a crumb of it yourself.
In the same way that being white, or cisgender, or wealthy, or male, provides a certain level of privilege, I am conscious that I have a level of ‘mental health privilege’. I have low level anxiety, easily medicated depression and was lucky enough to receive treatment for anorexia very quickly. People with schizophrenia, types of OCD, BDD and other less well understood mental health conditions are frequently misunderstood, misdiagnosed and remain heavily stigmatised. I fit within a socially acceptable idea of mental health, I have relatively predictable triggers and self-care does help with some of my symptoms. But it is important to remember that this is not the case for everyone. We should not kid ourselves into thinking that the stigma surrounding mental health has disappeared. It is not our job to become experts in every mental health condition, but being willing to learn, understanding nuance and acknowledging our own ‘mental health privilege’ can help us move beyond black and white triggers and treatments to a more holistic understanding of mental health.