Monthly Archives: April 2015

10 things I want you to know about mental health

Sometimes knowing what’s going on in anyone’s head is an area we all struggle with. It can be even harder to understand or guess at what is going on in the mind of someone trapped in mental health problems. And sometimes not knowing makes having an open and honest conversation a huge hurdle, it becomes the elephant in the room that everyone recognises but no-one is quite sure how to bring up. I thought I’d do a post on ten things that I, as someone with a mental health problem, want you to know about my illness.

  1. My anorexia was never about weight or being thin. It was about safety and taking up as little space as possible. I felt I did not deserve to take up any more than the absolute minimum space in the world that I could. Taking up more space felt dangerous- I might be noticed and that would mean I was unsafe.
  2. My eating disorder isn’t really about food. I still love food, if anything I love it more than before I was ill. I just won’t let myself enjoy it, instead it’s become an all or nothing experience. The foods I avoid the most are the foods I secretly love the most and wish I could eat.
  3. My external appearance doesn’t reflect the way I feel. Sometimes it may do, I may have a day where hoodies and leggings are the only thing I feel comfortable in, but most often I look well. I’m a 23 year old female with a wardrobe full of primark and new look dresses and skirts, I can be feeling at my worst whilst dressed in fashionable clothes with my make up done and my hair washed.
  4. Likewise I don’t look like the picture of a mental health patient that always accompanies any media article on mental health. I don’t spend much of my time with my head in my hands or curled up in a corner refusing to speak. At my very worst I did but that was in a psychiatric unit with very unstable grip on reality- most of the other patients were sat calmly watching TV or smoking in the garden. Very few of us looked ‘mental’. Here’s my mental illness selfie- would you look twice at me in a crowd? headclutcher
  5. Having depression doesn’t mean I’m always miserable. I can’t switch it on and off but often when I’m around other people my depression is in the background and I am able to participate in life. that’s not to say it’s easy and I don’t struggle, just that I can enjoy the lighter moments just as much, if not more so, as any ‘normal’ person. It’s when I’m on my own or not busy that my depression hits me hard and it becomes a self destructive cycle- the lower I feel the less likely I am to go out and the less likely I am to therefore enjoy/ experience the lighter moments.
  6. Self harm is not attention seeking. It’s one that should be obvious but it so often isn’t. I’ve come across a lot of professionals who tell me I’m using self harm to seek care and attention. That in reality couldn’t be further from the truth. I find having to seek help, even from my mum, absolutely mortifying and avoid it as much as possible. For me self harm is a way of getting the bad feelings and emotions out of me, perhaps closer to bloodletting than attention seeking.
  7. You can have a loving family and stable background and still have mental health problems. I firmly believe there is a biological/ genetic element to a great number of mental health problems. I come from a loving family who support me and care for me deeply. I am loved and come from a family that provides emotionally and financially for me and yet I still have long standing mental health problems.
  8. Anorexia and bulimia are not like the photos pro anorexic/ bulimic internet sites and instagram accounts show. They are not like the way lifestyle bloggers with anorexia portray. They are life threatening illnesses which take up your entire life. They are not baggy jumpers and cups of green tea- the reality is messier and darker and much more unhappy than any of these images portray.
  9. It’s not laziness that stops you doing things when you’re unwell. Depression can be paralysing and when I am becoming unwell the first thing for me to lose is my music. Not because I can’t be bothered or because I’m being lazy but because as I get more unwell the energy to just function becomes incredibly difficult to tap into, so anything extra brings about panic that I’m not going to be able to do it and that fear becomes a self perpetuating cycle which leads to a monotonous greyscale effect on life where doing the things that are pleasurable and enjoyable becomes too much to cope with.
  10. Mental health problems aren’t just ‘being  bit moody’ ‘having a down day’ ‘being happier than normal/ hyper’ ‘not being hungry’, They are real and life threatening illnesses. You can’t get a touch of depression or a day of anxiety or a couple of hours of anorexia. They are illnesses which take over and control your life to the extent that they can become your life at their very worst. Everyone feels depressed or anxious at times but not everyone has depression or anxiety, there’s a crucial difference between feeling nervous about an exam because you want to do well and feeling paralysingly scared about leaving the house for a reason you cannot put a name to. The same goes for depression, eating disorders, mania and a whole raft of other mental health problems.

Mental health problems are real and they are serious. They are illnesses, not adjectives.

Self harm, the reality.

Self harm. As many as 1 in 10 young people will engage in it at some point during their life and yet we almost never hear it talked about. I’ve written before about some of the stigma that comes with being a self harmer and about my experiences in A&E, this time I thought I would talk about the day to day reality of living with self harm.

My self harm started off, like many peoples, as minor scratching and cutting. Enough to draw blood but injuries that left only thin pale scars and put me at little risk. That doesn’t mean it’s okay. When I first started self harming I remember seeing pictures of severe self harm online and thinking that would never be me. That it would never get that bad. And yet here I am 10 years later still self harming and to a point where I require stitches and have needed a blood transfusion in the past. Out of interest I looked again at the photos that had so shocked me as a 14 year old and had seemed frighteningly serious. This time I was shocked, but for a different reason. My day to day self harm is often worse than the photos I had thought so terrible at a young age. That 14 year old who thought she’d never go that far? She has.

I think I can understand how my self harm has escalated to the point it’s at today. It starts of slowly, at first you think you can control it. You think that you can choose when and how you self harm. But it snowballs, like any addiction it becomes more demanding, requires a bigger hit for the same effect. At first you’re scared but then you become immune to it. Over time you lose track of what ‘severe’ and ‘mild’ really mean. When you do it every day it all looks mild. It was only recently when I was in A&E about three weeks ago that I realised this. I’d gone in with a very deep cut I knew needed stitches only for them to start worrying about the other cuts around it as well saying the needed stitches too. They were too old to stitch but those were my standard every day level of cutting and it was a bit of a wake up call to have them considered as needed stitches. Those were the cuts I just shoved a dressing over and got on with.

Self harm is insidious, it slips in to your life and then takes over your life. At my worst, when I was in hospital, everything became a weapon. Cutlery left lying around the ward was quickly stolen and hidden in my room, bit of glass from the ward garden, coke cans left lying around… everything suddenly took on a new dangerous meaning and it was like someone had taken over my brain and focused it on spotting sharps. I still struggle if I walk past broken glass not to instinctively pick it up and hide it, even though I have access to clean sharps at home. I never do but I cannot look at something sharp without thinking how I could hurt myself with it. Slowly you lose your identity to self harm, you do it so often in your head you become just another self harmer- if you didn’t do it what would you be? And your skin reflects that identity and strengthens it- your arms are a map of pain and suffering for everyone to see. You can’t wear short sleeves without stares and whispers or without feeling that everyone you pass is judging you. And you worry that to those that do notice you are just ‘crazy’ ‘wrong’ ‘another self harmer’ ‘attention seeking’…. the list is endless.

Self harm takes over your life in other ways too. Most of my friends would struggle to provide you with a plaster if you cut your finger at their house- at my house you’d have the choice of a normal plaster, a mepore dressing, gauze, opsite and numerous other wound care products. I have a first aid box my mum stocked up with full of dressings and steri strips and gauze. Then there’s the long sleeve tops- every summer is a stressful time. The hot days are beautiful yet agonising as you are forced to wear long sleeves to cover scars, long trousers, lightweight material to keep you cool and hidden.

And then there’s the act of self harming. The trance like state I get sucked into where it’s very hard to remember what I’ve actually done. For me the urge to self harm localises to a physical area on my body and intensifies until I give in and self harm. But there’s an icy clarity to the pain. There’s the rush of fear and adrenaline that kicks through you as you cut deeper and deeper, there’s the moment of panic when you hit a vessel and it sprays before calmness because you know you’re getting the badness, whatever it is, out. The pain never goes away though, you DO feel the pain when you’re harming, it’s just a different quality of pain from the normal pain you get when you’re accidentally injured. This pain is dull and slightly panicky but also feels strangely right- you’re doing this yourself and you can chose when it’s too much and when to stop. In theory at least. The reality is choice doesn’t come in to play with self harm- NEED, urge, desperation. All better ways of describing it, never choice.

Psychiatric soundtrack

Music has been a part of my life for as long as I can remember. Singing was a feature of my childhood- solos in the school play, being the youngest member of an adults choir, singing at the Royal Albert Hall with my school. It’s something I’ve always done and something I used to really enjoy. Violin too has been a huge part of my life, I started playing in year 5 and have continued to do so throughout my adolescence and early adulthood. Of late though my music has become a fear. Something I’m terrified to do and just the thought of makes me feel sick with anxiety. When I’m becoming unwell music is always the first thing to go, as soon as my illness takes over there’s no space in my brain for music. My singing I sadly no longer am able to do anyway as bulimia has destroyed my singing voice but I am still physically capable of playing the violin. I’m just terrified to do so. So I thought as a way of inviting music back into my life I would do a psychiatric soundtrack. Music is evocative and I want to include songs that have good and bad memories and associations attached and that have been important parts of my journey through mental illness.

The first song I have to mention is Rabbit Heart (Raise it up)  by Florence and the Machine. This was the song I listened to on my way to my first doctors appointment about my eating disorder. The first time I admitted I had a problem and needed help. I remember walking to the doctors surgery with this coming through the headphones and for some reason feeling the song strengthening my resolve to be honest about things.

Then there are the songs I listened to in inpatient. Christmas songs are forever tainted for me now. The Pogues, bandaid, wham… all take me back to the distressing and overwhelming first week of being in hospital, sat in the the dining room sobbing over a cup of milk, an omelette or an ensure. Crying over the portion increases whilst the rest of the world bubbled with the excitement of Christmas.

Later on in my eating disorders admission one of the occupational therapists introduced me to the music of Jessie Ware and I became quickly absorbed by her lyrics and surreal yet haunting melodies. Wildest Moments became my favourite song of hers and I would listen to her album on repeat in the break between breakfast and morning snack curled up in my hospital bed huddled under hoodies and blankets. Another song from that admission was Radioactive by Imagine Dragons. Now whenever I listen to it it takes me right back to sitting in the lounge with one of my friends, another patient, and watching TV for this amazing song to be played in the advert break. I immediately loved it and spent hours searching online to find it and have since downloaded and enjoyed all of the Imagine Dragons songs.

There are happy songs from that time too. My first home leave from hospital was to attend the Of Monsters and Men concert in Oxford with my mum and my sister. Listening to their music still takes me right back to that magical evening where I felt normal again for the first time in a long time. In the summer of 2013, shortly after I was discharged from in to daypatient I went to Cornbury festival with my mum and sister and saw my all time favorite artist live- Bo Bruce. Her music resonated so strongly with me. Echoes, Ghost Town and On the Wire especially so. That day felt amazing and free- I felt like a functioning human being out having fun, rather than a psychiatric patient on leave from a unit.

Once I was discharged from the unit back to outpatients I continued to see my therapist once a week. I wasn’t attending uni so would spend every day wandering the streets of London, walking up and down Fulham Road and to Clapham and Wandsworth and Fulham Broadway. I would find a starbucks and sit with a white americano listening to London Grammar watching the world pass me by. I love the music of London Grammar, the smoky voice and the haunting melodies. It’s sad overtones felt like they matched my mood, especially as I slipped deeper and deeper into depression.

In the summer of 2014 I was hospitalised twice again. This time in a a general psychiatric unit. It was the most frightening period of my life and I’ve blogged about it before. Whilst on the unit I vividly remember pacing round the garden, refusing all food for a week and walking around for hours a day, listening to Jessie Ware, London Grammar and Bo Bruce on the wireless headphones my dad got me (normal headphones weren’t allowed). During that admission the music channel was often on in the day area/ main ward area and the likes of Waves by Mr. Probz and Summer by Calvin Harris take me right back to sitting in a corner on the floor with my 1:1 nurse at arms length distance whilst I tried desperately to finish my dissertation, in complete denial that I was going to have to postpone my degree yet again. In lighter memories, Fancy by Charlie XCX reminds me of a patient who had previously not uttered a word singing ‘Dr X is a prick’ at the top of her lungs, a sentiment I whole heartedly agreed with!

And that takes me up to my final song. Say Something (I’m giving up on you) is my song of choice for the down moments. When I want to hear music but can’t cope with songs telling me how wonderful their life is or how much drugs someone takes. It’s quiet and still and is often my soundtrack on my twice weekly trips to my GP surgery for my medication.

And that’s my psychiatric soundtrack. A bit of a different post but one I’m hoping might pave the way for me to allow music back into my life.

Recovery isn’t always simple

One of the hardest parts of the place I am in in recovery from my eating disorder is that I no longer look sick. At my anorexic worst I looked visibly unwell, people were worried for my physical health and the internal hell I was living was reflected by my emaciated body and sunken face.

But with bulimia it’s a very different story. My weight is at the upper end of the healthy range, my thighs touch, my ribs and hipbones no longer protrude and I can sit down without suffering the excruciating agony of bones against hard chair. Looking at me you would think I’ve made an excellent recovery, that I am one of the ones who made it and lives a life truly free of my eating disorder.

You would be wrong. Because I am one of the many anorexics who transition to bulimia. It shouldn’t be a surprise, I suffered from bulimia from the age of 14 before developing anorexia at university. I knew all the way through treatment that I was in the group highly likely to develop bulimia instead of recovering from anorexia. It was one of the reasons I fought so hard to maintain a severely underweight BMI and why I refused to give up purging the entire time I was in hospital. It was why as soon as I was made a day patient I deliberately drove my BMI right back down again. Because I never did believe I would be one of the ones who recovered. I always knew I would be one of the ones who developed bulimia.

In hindsight I wish the unit had been stricter with me. Had forced me to talk about my bulimia rather than my outright refusal to engage when it came to talking about the bulimia. And in some ways I am very angry that when my bulimia first reemerged it was hailed as a positive- ‘but you look so much better!’ ‘but your weight is so much better’. My therapist was amazing and seemed to understand that the weight gained through bulimia was not recovery for me. It was simply a different way of killing myself.

Bulimia is the disorder no-one talks about. It’s my biggest shame. Whilst I found it fairly easy to be quite open about my anorexia, my bulimia fills me with shame and guilt. I feel disgust for the soft, womanly body I now inhabit and want to cry every time people tell me how much better I’m doing. Because in reality it’s all a lie.

In many ways my bulimia is very very similar to my anorexia. I am still tortured by the anorexic thoughts, every night I plan not to eat the next day, every opportunity to miss a meal or skimp is pure torture- I find myself frozen between “should I? Shouldn’t I?” Hours are spent in the supermarket reading packets. Dinners at work are made up of liquid calories and yoghurt because I cannot manage real food when I could get away without having it. My brain is a catalogue of calories, every item eaten is converted to it’s numeric basics. I appear to be doing well, I eat regularly when people are around, I cook meals occasionally now, I eat the meals my mum cooks and no longer rely on diet ready meals. I maintain a healthy weight. And yet my mind is in agony still.

And then there are the unpleasant bulimic symptoms that it’s often easier to gloss over. The sheer pain of binging, of desperate uncontrollable eating until you feel you might die and the agony of hours spent throwing up. The way your hands are calloused and cracked from the acid and rubbing on your teeth. The way it’s impossible to even consider keeping some foods down. And the anxiety after eating (even the smallest amount) and not being able to purge, the way you can feel the fat crawling across your body and smothering you, the food in your stomach immediately converted to pure fat.

And yet I look well. I look like one of the ones who recovered properly. Who is free from the grips of my ED. And nothing could be further from the truth. Because an eating disorder isn’t always visible and weight gain doesn’t always correlate with recovery.