Keep talking, but don't forget to listen

There’s a belief I want to challenge. One that prompts similarly phrased sayings that are tossed around frequently and readily, in an attempt to disrupt and ultimately lessen the stigma of mental illness.

“You wouldn’t feel ashamed of having cancer, the flu or diabetes!” “Taking antidepressants should be regarded the same guiltless way as a diabetic taking insulin!” “Physical illnesses hold no disgrace!”

Ring a bell? The medication one I hear most often. Taking insulin might be listed alongside treatments such as a cast on a broken leg, painkillers to nurse headaches, a plaster for an accidental wound. Offered as an aid that is seen as easy and without any questioning as to its need. 

I understand the perspective and the intention, but it’s so very inaccurate. 

Am I picking holes? What’s the harm, right? Wrong. It IS damaging. It adds to the mistaken regard of physical illness as entirely separate from psychological. While attempting to normalise conversations about mental illness, a regard for the emotional influence of some ‘physical’ conditions is being thrown under the bus. This is especially important in relation to ED-DMT1 and diabulimia. For those that struggle with an eating disorder and type-1-diabetes taking insulin is not an action that is thoughtlessly undertaken without fear or worry. In fact, it is far from, that fear can feel crippling.

The notion that there is no ignominy attached to physical conditions is a lie. This most related to the misconceptions attached to the presence of what are labelled ‘invisible illnesses’. Many people assume that if an ailment is not in plain sight it must not have any significant impact. This makes it harder to let some aspects of it be seen when they need to be. And honestly, the sheer principle that having a bodily malfunction that can never be fixed (unless there’s a cure) is not going to be mentally burdening is quite ridiculous.

There’s also the commonly held assumption that diabetes being like doing X and taking Y which will equal Z. This can often be based on interactions people have had with those that have type-2-diabetes which is treated by tablets and so rarely the cause of disabling erratic blood sugar levels. I mean, your friend tells you her grandfather is diabetic but it doesn’t let it affect him at all so why should it get you down!

Of course, it’s brilliant that the barriers around mental health stigma are being pushed through. Talking and overcoming our embarrassment over distress and anxiety and depression is a hugely positive thing, but that shouldn’t come at the expense of widening understanding of the link between chronic health conditions and emotional strain.

Moreover, if you don’t have direct experience of something you should always consider your words relating to it with care. Yes, we need to keep talking, but we also need to be listening more intently, with an acknowledgement that teaching is one success, but learning from others is another that is just as important.

By Claire Kearns.

Depression, diabetes and eating disorders

Depression: another big D word and largely silent, invisible illness. Standing alone it can be emotionally devastating and incredibly difficult to cope with. With diabetes involved, depression is often given further means to fester and grow quite dramatically, with stable blood sugar control often overlooked or given less attention than it needs to have. Most recent studies show that depression is twice more commonly found in individuals that have diabetes than those without. It has also been reported that around one in three people with long term chronic conditions experience poor psychological well-being, compared to one in four within the general healthy population.

But why? And how do we address it? Uncontrolled diabetes can be problematic enough to treat, especially with many health practitioners not addressing the emotional roots of the diagnosis at all. A dominating precense of depression can cause the pro-active approach a diabetic needs to take can fall easily by the wayside, with self-care becoming a burden. Of course, such despondency can often be a part of someone experiencing diabetes with an eating disorder as well. Depression, diabetes and an eating disorder make up a dangerous mix whereby each condition can be fuelled by the others, maintaining a cycle that is difficult to break out of.

Despite the high numbers of diabetics that also experience depression, any information available upon diagnosis is sorely lacking. You are typically given all the education that you need in relation to what insulin to take, what to do in cases of hypo or hyperglycaemia and which snacks are better than others, but what about the emotional issues? It seems quite rare that any insight or support is provided to acknowledge what coping with diabetes can do to your head.

Undoubtedly the realisation that type-one-diabetes is an incurable, unrelenting illness which will be with you for life can be difficult to accept at diagnosis. Then there's the possible perceived alienation from peers, the confusing and unanswerable question of 'why me?', the loneliness and isolation of it all. Furthermore, there is the urge to be free and able to do everything your friends can do without having to stop and test your blood/inject/eat every few hours. Such yearning can trigger a sense of denial and rejection of acceptance: what blind-sighted health professionals can term “non-compliance”. It can also be hugely challenging to deal with the influence of mixed media messages that can spread ignorance to the public and the barrage of unhelpful, intrusive comments that may come from the people around you. Nobody seems to tell you about any of this in the beginning.

Of course, this isn't always the case, some people do have good accounts of the process, where the right resources are offered and they feel supported. However, for every success story, there seems to be several other cases whereby a newly diagnosed diabetic is given a few leaflets, a clinic appointment in four months, and is then sent on their way.

Diabetes UK explains the following on their website: “Everyone reacts differently when they hear the news that they have diabetes. You may be initially overwhelmed, shocked, afraid, angry and anxious. Some people go through a stage very similar to mourning – as though they are grieving for lost health. “

Diabetes can also become a tool for self-harm, with suicidal behaviours complicating the issue even further. As well as the highly dangerous practice of omitting or reducing insulin which can be largely associated with an eating disorder, a sufferer of depression may misuse their medication in other harmful ways. This could be by overdose or purposely prolonging a precarious state of hypoglycaemia. Depression can jump on diabetes as a way of pushing the boundaries of life to a desperate and potentially lethal knife edge.

Patience Blystone spoke of how at the height of her illness depression provided her with yet another tool to hurt herself with: “Along with my eating disorder being shown through poor diabetes control, my depression has done the same.... Whether it's me screaming out for help or to be noticed, punishing myself because I feel I deserve that, or just neglect because I can't muster the energy to take care of my body.”

Talking about how she is now able to manage her depression more appropriately through an on-going process of recovery, Patience said: “I've coped with it by finding out what makes me depressed. I am a huge perfectionist, have terrible anxiety and in general am very pessimistic towards my own life. By realizing that setbacks won't ruin my life or make people dislike me, I've managed to always feel the need to be perfect. I can tell myself 'Well if this goes wrong I have THESE alternatives' and move on. My anxiety is a daily battle of tiny bouts of courage, tears, yoga, and just pushing past my comfort zone. And the being negative is just a day by day thing. I find if I enjoy the small things and try not to focus on the hard problems for too long it lessens.

Lucy O'Meara also believes that diabetes has played a role in the development of her depression. She talks of how the condition “majorly decreases (her) motivation which makes relapsing more likely and diabetes control go out the window.” Kayleigh Lovell, who was diagnosed with both type-one-diabetes at the age of six believes her own severe depression started gathering roots at the same age. “I find basic tasks like brushing my teeth or getting dressed almost impossible so taking care of my health is difficult. My eating disorder, OCD and depression have always prevented me from making my health a priority.” she says, “I often feel like I am committing a slow suicide.”

This is not to say that advances in treatment settings are not happening. Recent years have seen the link between psychology and diabetes being considered a lot more has been previously seen. Reports on the association of disordered eating have been a small part of this. Most significantly the National Institute of Clinical Excellence (NICE) released new guidelines which outline the importance of psychological support for children and young people with diabetes. They also updated their existing recommendations concerning this area in relation to adults.

But we need to continue making a noise.  Progress is being made in ripples but we need a crashing wave. If you are reading this and suffering from depression please speak out and don't be afraid.  There is nothing whatsoever to be ashamed of.  Vocalise your distress, shout about it if you must. Go to your GP, diabetic nurse, consultant or even a friend who can advocate on your behalf because you shouldn't have to suffer alone. Nobody should have to suffer alone or in silence. You deserve to be heard.

By Claire Kearns.

How Anxiety Can Feel

If depression is the black dog in the corner then anxiety is the gnawing monster on your back. It will cling to you, drain you of energy and leave you shaking like a steam train on rusty railway tracks.

If you'd told me a few years ago that anxiety would be such a significant problem for me I might not have believed you. Mental health issues have been familiar since my early teens, mostly that looming shadow of catatonic depression, but I'd never really experienced anxiety beyond what is considered the norm. It was only in my mid to late twenties that it started to creep up on me, and now at the age of 28 it is a constant, stalking presence.

There are two types of anxiety. Generalised anxiety disorder can develop as a nauseating terror that sits in your stomach. In can rush over you in waves, suddenly rising, falling and churning around like the inside of a washing machine. It stops you going out and tells you something bad will happen if you do, something awful. In response you squirrel yourself away indoors and avoid interaction with people which ultimately only feeds the original fear.

Acute episodes are those moments where you are pushed right to the edge and suddenly the world around you is distorted. Everything speeds up and you can't reach out or steady yourself. There are usually identifiable catalysts, the small errors that your mind can run with and blow up to extreme proportions.  Perhaps a smashed plate, a late bus, a spilt drink, the anticipation of a particular event or occasion that you are facing. Your head will play tricks; add two and two together to make five, and obsess to an extent where you feel tied in knots.

I am currently in London, dog sitting for a friend while she is on holiday. My aim has been to use the opportunity to meet up with friends who live nearby and be as social as possible while I am here. This is proving to be quite challenging and I am having to draw on various coping mechanisms to get by. Busy train stations and fast moving crowds are very much a trigger for anxiety, as well as the pressure of interaction with others. It is a wearing but worthwhile struggle to stay present instead of avoiding and retreating into a safe but ultimately smothering shell. But I refuse to give up and let anxiety win.

There can be some real strength to be gleaned from the familiar lesson "fake it till you make it". Although putting on a pretence long term is not a solution as recognising your own self worth is important, courage taken in small bursts of role playing can be beneficial. Take on the character of the woman stood next to you waiting on the underground platform. She is smart and has her head held high, she is on the way to work or an important interview or appointment. Transform yourself into her shoes and detach yourself from the mental processes that are holding you back.

 It is also crucial to try to understand that a situation may be less than ideal and bad experiences do happen, but it does not mean the end of the world. Ask yourself ‘what’s the worst that can happen?'  Then keep questioning and pushing, "and so what if it does....what would that mean?' 'So what if I do make a fool out of myself, so what if someone doesn't like me, so what if I get into a disagreement.... so what? Why does it matter?' We all mess up and make mistakes, it is part of being human. You may come up against judgement, discrimination or prejudice, but that has more to do with the instigator than it does about you. Not caring about the insignificant things is far more difficult than it should be, but it is a goal that can be achieved with practice. In turn, be patient with yourself and recognise baby steps that will eventually add up to a mile. It is easy to throw in the towel and label yourself a failure if you do not manage to do something you intend to, but on the days that you just make it as far as the end of the road when the day before you only made it to the front door, that is still a success!

 My own anxiety manifests very much in a deluge of thoughts that run through my head at marathon speed. I am usually able to distinguish irrational from rational but when my anxiety is particularly raging it can be harder to do so. Paranoia sets in and I find myself interrogating myself and harshly assessing my every move, how I look, how I act, the words that come out of my mouth.  Even after walking away from social situations I will pick apart my actions with a fine tooth comb and find imaginary evidence to support flaws and wrongdoing. Regret. Guilt. Self-hatred. I have to step away for a second. I have to try and remind myself that I cannot rely on those thoughts, I cannot trust myself. It is common for me to want to seek a lot of reassurance from other people but I also have to resist this doing too much, as it can create annoyance and unease where there was not even an issue to originally address.

Being able to identify and separate the physical elements of anxiety from the mental is also really important. The racing heart and quickened breathing that may come on either in a fight or flight nervous episode, or as a result of mental distress, is simply the body's reaction to panic. It does not mean that you are in any actual danger.

 Distraction is a key element in addressing anxiety. If available to you, talking therapy can be of great benefit. But individual mindfulness exercises or meditation can also make a real difference and there is an array of Mental Health literature and information available in relation to practicing both. Adult colouring books or games that sharpen your brain into a focus beyond the anxious feelings can also be of great use, as well as knitting, drawing or writing. It is okay and entirely healthy to need time out and space to yourself. Make a list of activities you can read through and try out during those moments when everything starts to feel too much and your mind becomes too distorted to think straight. In doing so your anxiety should gradually begin to lessen until it is at a more stable level.

Most of all remember you are not alone. Mental illness can feel personal and isolating but it is far from uncommon. According to anxietyuk.org More than 1 in 10 people are likely to have a ‘disabling anxiety disorder’ at some stage in their life and an estimated 13% of the adult population will develop a specific form of anxiety known as a phobia at some point. That woman next to you on the tube platform could have just repainted her face after an emotional breakdown among the crowds. Reach out if you feel yourself slipping and let others support you. Good friends will be there to hold you up when you are lagging.

Anxiety might often feel completely overwhelming but it can be controlled and contained. Although it is unlikely to ever be a complete after-thought, it can be put into a box that sits in the background of your thoughts, which slowly through experience and the testing out of different situations will become smaller. Try to enjoy spending time with other people and letting them spend time with you. Those moments can be treasured and put into a new box of positive memories.

By Claire Kearns

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This article was originally written by a DWED contributor in 2016 and then published by www.healthisyourwealthmagazine.co.uk. It is reproduced here by the author for Mental Health Awareness Week.

BREAKING NEWS: NOT ALL THOSE WITH MENTAL ILLNESS ARE CRAZED MURDERERS

This is an old piece I wrote for DWED's past website which centres on the dire state of some newspaper reports on mental health. Sadly this is still a very relevant topic which is why I am re-publishing for Mental Health Awareness Week 2017:

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Monday’s disgusting front page article from The Sun Newspaper has been quite rightfully blasted from all corners. It’s scathing headline “1,200 KILLED BY MENTAL PATIENTS” is glaringly unsettling and sensationalist on first impact. The article that follows reads as damaging and woefully inaccurate. Social network users were responding to the tabloid in force last night, with many calling for a full apology from the paper.

A response penned collectively by charities Time to Change, Rethink Mental Illness and Mind condemns The Sun piece as ‘disappointing’ and ‘damageable’. They state that it “will only fuel the stigma and prevent more people from seeking help and support when they need it.”

Information that The Sun article is based upon is twisted to suit a scaremongering, screaming agenda. Their headline, while based on the message that many people have been let down by mental health provision, is distorted into an attack and focuses on minority details. First of all there is no such thing as ‘mental patients’ but instead individuals that struggle with poor mental health – sorry to break your monstrous and unstable, axe-wielding image there Mr Murdoch. True figures reveal that the number of homicides carried out by those with mental health issues, including those experiencing psychosis has decreased.

The Sun also conveniently failed to mention that suffers are in fact ten times more likely to be victim’s, rather than perpetrators of crime and violence than anyone else. They are also a much larger risk to themselves through self-harm, neglect or suicidal intentions than they are to others. Mental illness can quite often be secretive and contained with many sufferers going about their lives without ever harming anybody else. With the right treatment many can go on to fully recover.

In spite of the reality, sadly the stigma against those suffering from mental illness is still rife. Research by YouGov revealed that people with mental health problems are regarded as the most discriminated-against group in Britain.

A petition has been started by Twitter user and psychology teacher Rhiannon Lockley at Change.org. Miss Lockley requests that The Sun “Recognise that they have acted unethically in misrepresenting information about the mentally ill in this harmful way, and to print a full correction to this effect.” while also asking them to “Make a donation to mental health charities to cover any profit made from this story and to apologise to those misrepresented.”

By Claire Kearns.