'Tis the season

The Christmas period often sees a spike in mental health crisis calls, as the season can make people feel the pressure of loneliness, the enforced happiness, the need for a perfect and magical time. Christmas is sold in adverts and films as a magical period of music, food, family and cheer; a time of traditions that must be adhered to and treasured memories that must be made. I have always put a lot of pressure on Christmas, and on myself to ensure the best and most perfect Christmas. I would fret about traditions, no TV, perfect food and board games. Which was exhausting enough, and then my son was born. On his first Christmas he was almost four months old and I was in the grips of postnatal depression. I can clearly remember the anxiety in the lead up to Christmas day over how the day would pan out- when we would eat, how I would cope with the newborn drudgery on a day that was supposed to be full of wonder and excitement. I was dreading the day, because I knew that my son would still cry a lot, might not sleep, and that it was unlikely that we would eat dinner together as he would not be put down. The shadow hung over me in the lead and the day itself. I don't really remember much from that first Christmas as a family, a walk in the snow and some presents. But I don remember being so upset tat it essentially felt like any other day with a baby- nappies, crying, jiggling, pushchair walks for sleep. And it made me feel like I had failed at Christmas, failed to live the magical experience sold to me by advertisers and the media. And yet there were no disasters, I had family, a Christmas dinner and beautiful baby. It wasn't the failure of the day, but my excessive expectations that had ruined my Christmas experience. As he got older Christmas improved as his excitement and understanding replaced the newborn fog of crying and feeding. History repeated itself wen I my daughter was born. Her first Christmas came only a few weeks after I was discharged from the Mother and Baby unit that I had stayed in for 8 weeks. Although better and more stable than I had been, I was by no means well and the anxiety started creeping in again. This time the added pressure to ensure that my son had a magical time, full of family and presents and excitement. That Christmas day I spent two hours walking my daughter in the pushchair around our village, crying on and off at the fact that this was my Christmas and I ate my Christmas dinner standing up holding her and in shift with my mum. I had family around me, a roof over my head and all that jazz, but I was still unhappy. Mainly because I was depressed and anxious, and because I felt an enormous pressure from the 'pintrest' culture of Christmas to have new traditions, Christmas eve hampers, elves on shelves, and numerous complicated side dishes for the dinner. I'm not ashamed of how I felt, that I should have somehow felt grateful for all that I had. In fact that is part of what was contributing to my despair- the concept that I was in fact very lucky to have two healthy children, a loving family and a roof over my head- and I was still so unhappy. It was another stick to beat myself with. It wasn't what I had or didn't have that was fuelling my depression- depression can happily fuel itself without any outside factors- but my unrealistic expectations of what Christmas should be. A few months later I started therapy as part of my treatment, and one of the overriding themes of my sessions was my unrealistic expectations and how I dealt with what happened when these expectations weren't met. It helped me to practice 'failure' in meeting expectations and how to change my expectations to make them manageable. Because of this I dislike the constant Christmas pressure on social media, instagram and pintrest. I am wary of 'elf on the shelf', elf school, gingerbread house traditions, hampers of any kind and anything that created pressure for magic and joy. Christmas day will come and there will be magical moments when Santa arrives, when longed for gifts are opened. And there will be everyday moments of cooking, tantrums and TV. And that's ok, because no matter what the blogs and the pintrest trends would have you believe, it is just another day and amongst all the magic and excitement, the ordinary still has to happen. When you see all the pictures of cheeky elves and reindeer food, remember that nappies still need changing, washing up is still being done and children will still tantrum and squabble. And actually the magic is often in the mundane or the unexpected- the most loved present might be cheapest, tattiest least likely gift and the magic might come in the quiet, ordinary moments. The last few Christmases have been great, no newborn tears, rainy pushchair walks with screaming baby, but most of all just relaxed and not full of anxious of what it should be. I don't have anything to do with elves and hampers, traditions and timings. I am excited to see the magic of Santa in the eyes of my children, and to relax with my family. But I imagine someone will cry because they are tired/hungry/three and the mundane things that are life with small children will remain, but this year I will be looking for the magic in the small things- the smiles, the hugs, the giggles and not worry that the whole season isn't a magical wonderland. And if I have moments of sadness or boredom or frustration that is ok too. If know someone depressed or suffering with mental health problems, don't over egg the points that are good in their lives, as if this will be enough to lift them from the fog- instead of bringing appreciation it will likely bring further guilt, such is the cruelty of mental health. Instead be there for them, tell them its ok to be sad, to be upset, to find Christmas a struggle. And rather than force the magic with elves and reindeer and stressful traditions, bring the magic to them in the small things, the everyday- a smile, a hug a favour- show them that the pleasure in Christmas can be in the ordinary not the over the top.

Sharing is caring

Sharing is caring, or so I say to my children when I want some of their chocolate! Except sometimes sharing is scary, no matter how much you believe in openness. I'm passionate, evangelical in fact, about reducing the stigma surrounding mental health by talking about it, opening up, refusing to hide my diagnosis, my experience. But that doesn't make sharing easy for me, doesn't mean I do it freely and without worry of consequences. I had become quite complacent at sharing my experiences, talking openly about mental health. If I'm honest this was because everyone I was talking to already knew, those doors had already been opened, those shaky bridges tested. I was sharing in an echo chamber, with no danger of repercussion. And then recently I started a new job and with this came new colleagues, new Facebook friends and a whole new set of people who didn't know. Here was my opportunity to preach my message again, prove my openness. And it terrified me. What if the slightly odd glances started, the 'are you ok' looks. What if once it came out any chance of friendship and working relationship was ruined along with future chances of promotions and progression? I'm ashamed to say I hid some new colleagues on a Facebook post, changing the settings so they couldn't see. Not really in the spirit of transparency that I have been so vocal about. And so I took a leap, a stumbling, clunky chance during a conversation about having babies. I admitted that having another baby would probably break me, and explained what had happened to me. But our conversation was cut short, and I worried all that night, convinced that I'd made a mistake, that I'd return to work to find my colleague moved away. I hadn't. And I've since shared more via a fundraising event that I'm doing. And it feels like a weight has been lifted, and now I can be more honest about who I am. But I imagine this will happen again in the future and I hope I am less fearful and able to be honest without worrying about what might happen, how people might perceive me differently. And every time I do share with someone new and they are supportive I get a little bit closer to that reality.

It's not all in the mind

"People with severe mental illness die on average 20 years younger than the rest of the population, largely owing to physical health. People with severe mental illness are more likely to develop preventable conditions like diabetes, heart disease and some cancers." (Rethink mental illness) This statistic shocked me when I first saw it as part of the Rethink campaign "20 years too soon". However, recently I am beginning to associate this trend with my own treatment by doctors. Rethink assign four main reasons as to why this might be the case: medication side effects, life style factors, lack of physical health checks and most interesting to me, diagnostic overshadowing. Many of the medications prescribed for serious mental illness include some very serious side effects. One of the drugs I take is lithium. It is the most effective mood stabiliser used for people with Bipolar disorder, a salt originally designed for epilepsy and whose workings are not fully understood. There are potentially many weighty side effects to lithium, including kidney failure, thyroid malfunction and lithium toxicity. These are tested regularly through blood tests, and in my experience taken very seriously. In a similar manner once a year I have a full check up, in theory. In reality I have my blood pressure checked, height and weight measured and a nurse asks me bizarre questions about my family support, crisis help knowledge and work situation. Not exactly a full MOT, but it ticks the boxes. I have written before on the issue of being defined by your mental illness and this includes by health care professionals. Diagnostic overshadowing is when any physical symptoms you report are associated or dismissed as being a symptom or manifestation of your mental illness. On many occasions I have explained a physical symptom (headache, stomach pain, muscle pain) to be immediately asked "and how are YOU?" The emphasis on the 'you' designated the social shorthand for- you know, mentally? Another favourite is "are you stressed at the moment?" (I'm a teacher and have two small children, stress is relative!) It is entirely possible and likely that some or all of these symptoms may be a response to stress or mental health issues, but even when I am entirely well and can discount any extra stress I can sense that I am not believed. And on most occasions no further physical tests or investigations can take place. Today I experienced this dismissal in its fullest, leaving me feeling angry, ignored and still suffering symptoms. It was also a great example of the strange bureaucracy that slows down treatment. My most recent blood tests show that my lithium level is below the therapeutic level, meaning I am effectively unmedicated at present. Not good, and understandably triggering an appointment with my GP. Sadly, my GP can't actually alter my dosage, I have to contact my Psychiatrist for that. I'm waiting for the call back, and the letter to GP which will allow them to alter dose. However, the main issue for me (I'm so used to the bureaucracy) was the way my other physical issues were dismissed. Along with lithium, my kidney function, thyroid function and haemoglobin levels were checked because I have been unnaturally tired recently and I need to urinate very frequently (every 15 mins and 4-5 times a night!) When the tests were reported as normal I asked the GP about these symptoms. I was simply told these were probably 'just' a side effect or perhaps next time I could get my blood sugar tested. Next time, so in about 2 weeks minimum. It is very possible that these are side effects, perhaps from medication or low lithium levels. It could be something simple like an infection. But for me these are real physical symptoms causing me daily problems and potentially something completely unrelated to my mental illness. I and other sufferers deserve to have these physical issues taken seriously even if they are side effects, but especially investigated in case they are not.

The 'M' word

Mental health has been at the forefront of the media this last week, following the tragic Germanwings plane that was likely deliberately crashed by the co-pilot. The media is most interested in mental health when it involves celebrity or violence. I watched last week as the story unfolded from the initial reports of a tragic crash, to the slow realisation that this was not a technical error or human failure but a deliberate action of one man. And that is where the reports start to change, you can almost sense the excitement of the journalists uncovering pieces of an individuals life and medical reports, theorising and inferring where there was no solid information. The headlines included "Why was he allowed to fly?" and "Madman in the cockpit". A not very measured response from the media, attaching immediately to the possible diagnosis of depression, which in the first days referred to a period of time six years previously. Mental health violence, the "madman", the secret psychopath makes a good story, which is still being added to each day. And yet despite the revelation that the co-pilot may also have had eyesight problems, it is his depression and mental illness that continues to hold the attention of the media. I am certainly not going to deny that violence is sometimes a consequence of mental illness, but the data shows that a very small percentage (7.5%) of crime committed by people with mental illness is a direct result of the mental illness In fact people with mental illness are far more likely to be a victim of violence than a perpetrator. However due to media coverage of the mentally ill as crazed killers and out of control psychopaths, people typically associate random, unexplained violence with mental illness. Heather Stuart showed that people most fear violence that is "random, senseless and unpredictable" and they would prefer to know that a crime was committed as part of a robbery, which they can make sense of, than as a result of someone with a psychotic illness. Add to this a study that shows that the each widely publicised attack involving someone will mental health increases the public's real social distancing from mental illness, in other words and increase in stigma (Angermeyer and Matschinger in Stuart Apart from my love of studies and evidence this reassures me then that this stigma, this increase in discrimination is real, and only increases with the kind of media coverage experienced this week. I am certainly not suggesting that mental illness did not play a part in the actions of the co-pilot and understand the need to find answers and explanations for such tragic events. But it must be measured against the quick to blame mental illness attitude- he must have been mentally ill- must have? Must all inexplicable actions be written off as mental illness? The truth is most people with mental health problems are only of danger to themselves. The mentally ill are you teachers, police officers, nurses, train drivers, shop assistants, cleaners and care workers. As Alistair Campbell eloquently said this week

We may never fully understand why Lubitz crashed flight 4U9525. Despite that, the assumption that his mental health was the sole reason 149 others died will do nothing to diminish the stigma attached to mental health problems...if he had cancer we wouldn't be blaming that and banning people with cancer from working

What we need to do is demystify mental illness, not as a caricature of the psychopath or crazed killer, but as a very common, sometimes scary illness that can be very effectively treated. Because if the media demonise it as something that leads only to inexplicable tragedy, then less people will step forward and potentially receive treatment. I have Bipolar disorder, a sometimes psychotic illness, I'm a little bit strange but I'm not a danger to anyone.