Mental Health Awareness? I’m Over It

Two weeks ago (yes, it is June, yes, time is exhausting) was Mental Health Awareness Week. The theme of the week was kindness, designed to tie the numerous acts of kindness and flourishing communities that have emerged during the Covid-19 pandemic into the broader idea that kindness can enhance the mental health of individuals and communities alike. 

There is significant scientific evidence that being kind and receiving kindness can be beneficial for our mental health. Volunteering online, checking in with friends and families, dropping some hygienically-baked cake off for a neighbour – all these activities can boost your self-esteem, foster a sense of connection and create a sense of purpose during this mad time. The kindness theme is also designed to emphasise the importance of being kind to yourself by taking a break from social media, dancing around the kitchen or taking a long bubble bath. ‘Now is the time’, the Mental Health Foundation website reads, ‘to re-imagine a kinder society that better protects our mental health’.

It is a lovely idea. ‘Awareness’ and ‘kindness’ are not terms that should be dismissed – my own recovery from anorexia and depression owes much to a growing awareness of the deeper roots of eating disorders, to the kindness of others and to my own attempts to practice self-care. It owes more, however, to my therapy sessions, my dietician, my parents’ ability to send me to a private clinic while I waited three months for an NHS counsellor to become available. It owes more to my daily dose of anti-depressants than it does to a boogie in my bedroom or flowers from a friend. It owes more, in short, to money.

There are two problems regarding the glorification of ‘awareness’ and ‘kindness’ as mental health treatments. The first is a gap in understanding when it comes to what these terms mean, and the second is that both are futile without adequate funding.

In popular discourse, mental health awareness means a chat. It means knowing that at any one time, 1 in 4 people are suffering from a mental health condition, knowing that mental health is something we all have, knowing that it should not be a source of shame. For those suffering acute mental health problems, awareness means something else. I can only speak from my own experience, but perhaps it would be helpful to outline what awareness means to me. 

Every morning, I wake up and consider not taking my medication. I take it. Every meal, I consider not eating enough, or taking a secretive trip to the toilet afterwards in order to purge. I eat enough, and I do not purge. Every time I eat, I calculate the calories I have consumed – and every time I exercise, I calculate the calories I have burned. Every minute of every day, I am aware that my brain is not well, that it has thoughts that seem entirely separate from myself. I am always aware of my anorexia and depression. And I am always aware they may never leave me.

I face a similar disconnect when it comes to how kindness is understood in relation to mental health. The Mental Health Foundation website highlights ‘doing something you enjoy’ or ‘doing something for a good cause’ as ways to practice kindness towards yourself and others. These are, of course, acts of kindness. But when it comes to helping someone going through a mental health crisis, sending them some chocolate or getting them to volunteer should be viewed more as lovely bonuses rather than foundational acts of kindness. When I was ill, self-care involved valuing myself enough to brush my teeth. The acts of kindness I remember are my mum sitting with me while I spent 30 minutes eating a banana, or my counsellor kindly but firmly telling me I was facing hospital admission if I continued to exercise. They were not well meaning gestures – they were critical to my survival and recovery.

The second problem is that no amount of ‘awareness’ and ‘kindness’ is equivalent to sufficient funding. Fears that lockdown will trigger a mental health crisis are well documented, but our obsession with the consequences of Covid-19 risks ignoring that even without a pandemic, NHS mental health services are in dire need of additional funding and support. In December last year, the BBC found that while nine out of ten patients have their first appointment within six weeks of being referred to NHS mental health services, that gap between appointments is growing, with one in six patients waiting over ninety days between their first and second appointment. Schools are increasingly likely to bring in private counsellors to support children who cannot access NHS services, and the scattergun approach to funding has created a postcode lottery when it comes to surviving a mental health crisis. 

We have become so aware that everybody has mental health that we have forgotten that some people have serious mental ill health. In general, talking to a friend is a wonderful way to support your mental health. In the midst of an episode of psychosis, anti-psychotics and paid, professional treatment are critical. In general, playing some happy music and baking a cake is a lovely form of self-care. In the middle of a bulimic binge-purge cycle, cognitive behavioural therapy and nutritional guidance are crucial.

Absolutely, bake that cake. Buy those flowers for your mum, socially distance with a smile. Be kind, be aware. Be aware that these things are not treatments, they are not cures. Be aware that the only way out of our mental health crisis is adequate funding, and know that the negative consequences of austerity are still being felt by those in need of mental health support. Be aware that kindness is not, and never will be, enough. 

2020 Calling 2010

Dear Lauren, aged 11 years and 8 months

It’s Lauren, aged 21 years and 8 months here! I can happily report that the next (last?) ten years look nothing like The Hunger Games, or any of those other post-apocalyptic books you’re obsessing over. 

I don’t want to give you any spoilers, but I know you’re a worrier, so I thought some advice might come in handy as you navigate the next (last?) decade. Some of it is silly, some of it is serious, all of it is important – so grab a plate of BN biscuits, curl up in a corner and read on…

  1. First things first: the teeth will (almost) get sorted. The punched bunny look will disappear, but only through years of braces and retainers. You’ll still worry about them in ten years time – but at least by then  you can find gumshields that fit.
  1. So, secondary school. Bad news – exams never get easier or less nerve-wracking. Good news – you seem to do quite well in them. You might not ever grow to love secondary school (hard to believe now I know, you goody-two-shoes) but stick with it.  You will make gorgeous friends and find phenomenal teachers (keep hanging around Politics and English). You will also miss every single deadline, have several panic attacks in the loos and really have to grit your teeth to get through sixth form. Keep at it. The hockey, laughter and cookies are worth it.
  1. Speaking of hockey – grab that stick and don’t let go. You won’t swim for Great Britain, and you’re unlikely to be the next big thing in lacrosse, but you’re alright at hockey. The confidence you feel on the pitch will begin to seep into other areas of life, and it will keep you going when the proverbial hits the fan. Which brings me nicely onto a crucial life lesson you repeatedly ignore…
  1. OTHER PEOPLE’S EMOTIONS ARE NOT YOUR RESPONSIBILITY. Countless therapists will tell you this in countless ways – I’m not sure you will ever listen, but its worth a try. 
  1. Spoiler alert – you’re not married. Your failure to secure a date to the Year Six PGL disco was a sign of things to come. But, you’ll hone the art of third wheeling, and will dish out relationship advice left right and centre despite having no experience whatsoever. Maybe start listening to some of it yourself?
2010 – Always the bridesmaid, never the bride
  1. You are not Hermione Granger, and you never will be. Get over it.
  1. I know you think you hate parties and social events that involve more than five people, but I promise they can be fun. However – for the love of God, learn to handle your drink. Stop when you get giggly; by time you’re on a table, things have gone too far. Water is your friend. Anyone offering you vodka is not.
  1. Your body is not a representation of your worth. Don’t delete the pictures from that America holiday because you think you ate too many pancakes; don’t obsess over other pictures when you didn’t eat enough of anything. Eat the pancakes. Enjoy the pictures. Move on.
  1. Write things down. Write passionately, write angrily, write gloriously. It doesn’t have to leave your bedroom, and a lot of it will be drivel, but it will help you make sense of a nonsensical world. It might even be the answer to ‘what do you want to be when you grow up?’ (assuming the clarinet CDs/ swimming medals/ fairy cake business fail to provide a sensible income.)
  1. The next decade will be pretty rough, but it will also be pretty magnificent. Grab hold of the things that matter. Strive to be a better feminist, environmentalist, sister and friend, but forgive yourself when you slip up. Forgive others for their slip ups, but don’t worry about leaving those behind who can’t do the same. Wear big hoops, stay firm in your beliefs and don’t stop eating chocolate, no matter how hard it might sometimes seem.

Love you Loz. 

From, Lauren x

Mental Health Awareness Week

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.

Charly Clive, star of Channel 4’s ‘Pure’. The programme is based on Rose Cartwright’s real life struggle with Pure O, a type of OCD

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. 

My favourite self care expert

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.

The Naked Truth

Kat Harbourne and Jen Eells have a podcast. On that podcast, they interview women, from all walks of life about all sorts of things. Its much like several other podcasts that I listen to, except that when they interview their guest, they’re all naked.

It might sound like an odd premise for a podcast. After all, the listener can’t see Kat and Jen or their guest, there’s no live audience to ogle the naked flesh; it is easy to assume that the nudity is a gimmick designed to make The Naked Podcast stand out from the crowd. But after listening to any episode, it becomes clear that there is much more to this podcast than meets the ear. The guests bare all – flesh, stories, emotions, musings – and within a few minutes of derobing, they often sound as though they had known Kat and Jen for years. Even more interesting than the reactions of the guests is the development of the hosts throughout the series. The nerves of the first episode have long since vanished, replaced with a love and respect for their bodies that is not forced, is not artificial, is not saccharine. It is not present 100% of the time – body positivity activists are incredible people, but occasionally it can feel that if you do not love all of your body all of the time, you are not truly body positive. Kat and Jen are honest about their insecurities and open about the journey the podcast has led them on. In the first few episodes, they talk about the slimming group that Kat has joined; by the most recent episode, they are asking their guest, Mary Mutch, to be more forgiving towards her own body.

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The Naked Podcast

Each episode kicks off with the three Naked Truths. These are:

1.How would you describe your body?
2.What are you proudest of your body for achieving?
3.How do you feel about getting naked right now?

When I started thinking about this post, I wasn’t sure whether or not to answer these myself. But the very fact that I started getting uncomfortable when made to consider my own body and my relationship with it convinced me that these are important questions, not only for me, or the guests on The Naked Podcast, but for anyone who covers up in the gym changing rooms, or avoids their naked reflection in mirrors, or has ever tried a diet. So I’m going to answer the first two Naked Truths (the context of the podcast is sort of important for the last one, so I’ll save it in case I ever manage to sit naked with two lovely ladies from Sheffield.)

How would you describe your body?

There are numerous ways to describe my body. From an objective perspective, I’m about 5’6 and blondish. My knees are scarred from hockey pitches, I’ve got slightly rough skin on my arms which I am constantly being told off for messing with. I’m a healthy BMI (Body Mass Index) for my height and age (although I’m undecided how much store I set by BMI.) I have a straight line of moles on my neck and a very faint birthmark on my lower back. But before any of this, when I am asked to describe my body the first word that comes to mind is deceptive. I don’t always trust my body, I can’t always accept that what I see in the mirror is a reflection of reality. Sometimes it is too large, sometimes too small, often the wrong shape. Sometimes I am happy with what I can see, sometimes I am frustrated – I am rarely at peace with it, but increasingly I can maintain a ceasefire instead of all out war.

2. What are you proudest of your body for achieving?

I find this question easier than the first. I don’t need a consistently positive relationship with my body to recognise that it has achieved a lot in the past three years, despite my best efforts. The obvious – but no less truthful – answer is that I am proud of my body for getting me through a marathon. It got me through the 26 miles, and it got me through the hundreds of miles that I did for training. It healed injuries, dealt with the Beast From the East and coped with every mistake I made, from nutrition to training to clothing. But I am also proud of my body for getting me through my eating disorder. I abused and bullied my body, I denied it the fuel it needed to function. I pinched, pulled and pummelled it, forced it to devour itself in order to exist. And yet it survived, and I will always be proud of my body for that.

Find The Naked Podcast BBC Sheffield, The Naked Podcast, or follow them on Instagram at @TheNakedPodcast and Twitter at @TheNakedPodcast

Recovery

Almost two years ago, I found myself in a toilet stall in Malaysia, on the phone to my parents back at home, verbalising for the first time that my mind no longer felt like my own. After a month away from home, the Anorexia that had been controlling me through much of my final school year had grown into spitting, skeletal monster that had wrapped itself around my brain, distorting my perception of everything around me. The relief I felt when I finally said the words out loud was unparalleled, and in the weeks following my return home I felt like progress was being made. I had accepted I had a problem. I was receiving the counselling and nutritional guidance I needed. University still seemed like a sensible goal come October. Surely, the gap from diagnosis to full recovery would be a matter of months?

Unfortunately, this was not the case. I spent large parts of my recovery being told that I was brave for talking about my illness, and that I had overcome the biggest hurdle by accepting that I was unwell. But for several months after my first counselling session, I continued to feel that surge of euphoria when I stepped on the scales and the number dropped. I continued to weigh out my food, count my steps and calories, continued to overexercise. Recovery is not the neat, brief process I had imagined it to be, and accepting I was unwell was not the most difficult part. In fact, it became a new tool for the Anorexia to use; if I had accomplished this step, there was no need to try new foods or gain the weight back. As long as I was talking to people about the fact that I was unwell, I didn’t actually need to do anything to address the problem. I ended up in a bizarre situation where I could openly discuss my plans for recovery whilst edging closer to hospitalisation; I took a twisted pride in my manipulation of the situation, kidding myself that I was fooling those around me into believing I was engaging in recovery even whilst I faded into a bruised and delusional skeleton.

 

Recovery is not a smooth process, and it does not take mere months. I took an enforced gap year and when I finally reached university just over a year after my original diagnosis, it was not the experience I had been led expect from friends and the media. How to manage freshers’ week when you can’t bring yourself to drink alcohol for fear of ‘wasted’ calories? How to talk to someone you like when you are internally assessing every physical flaw you possess? How to deal with deadlines when you are too depressed to get out of bed? I made some fantastic friends, have a hugely supportive family and have medication to manage my depression, but first year has been a struggle. I have recently returned to counselling after verging on a relapse during exam season, and have been booked in for a bone density because I have not had a period in over two years. The fantasy of the rapid recovery I had talked about with my parents over the phone in Malaysia is laughable now, but not an uncommon perception. Mental health recovery is not smooth, it is not a journey of self discovery, it is not glamourous. I am still on antidepressants, still obsessed with food, still capable of spending hours at a time in front of a mirror dissecting my body. The body that may not be able to bear children because of what I have put it through, the body that I continue to berate and critique on a daily basis. 

Recovery is the best thing I have ever done, but let no one tell you that it is not brutal. It is necessary. It is the only option, but it may take years and it will not be without struggle. Do not be cosseted by the notion that talking is enough; it is crucial, but you have to act on your words. I have to act every day to prevent the monster feeding on my hunger, and it is empowering, exhausting and exhilarating all at once. But it is a battle I am proud of and a battle that is happening in every country, city and home every day. You are more than your illness, more than your recovery and every action you take creates a new identity that is not defined by these things.

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Previously posted on https://foodfitnessflora.blog