Category: Anxiety

Coping – a skill seldom taught

On By doctorlunnersIn Anxiety, coping, Depression, Doctors, GP, mentalhealth, Mothers, NHSLeave a comment

Today was one of those days. Why do ‘one of those days’ happen? Does one unfortunate blunder happen and someone somewhere decides you’ve now signed up to a day of similar delights? I’m guessing we just notice these delights more. Either way today was one of those days. The highlight was my waving goodbye to 13 years no claims bonus and a wad of maternity pay by reversing into a lovely lady’s car. I then drove to a bodyworks place where the guy did his level best to not judge my lack of knowledge on basic repairs, insurance claims and the registration number or make of my car. One of those gem of conversations where you are fully aware you are doing feminism no favours.

This all got me thinking about how we cope when things are a bit tough and I guess is a follow on from my previous blog on mental health and life-is-tough syndrome. There are a lot of recurring coping strategies that I find come up both in my work and in life in general.

How to cope is never something we are taught, or generally talk about when we are blossoming teens. It’s like filling in a tax return. If we were all taught how to fill in a tax return and how to cope at school I think we’d all be a lot less stressed at the end of January. But no, we have to learn the recorder instead. (Disclosure: I loved playing the recorder).

Obviously how to cope can be a very personal thing, but here goes a stab at what I think are common coping tactics.  

Be kind to yourself

So I drove away from the literal car crash earlier and stopped half way up the road to have a cry about how stupid I am. Yes, it wasn’t my finest moment, but it really wasn’t a disaster, accidents happen and could have been a lot worse and all that. Unless you’re a narcissist (google it, I guarantee you’ll know one), we are all generally very quick to find some kind of fault with what we do. Our automatic reactions are too often full of badness, and moreso when we are generally not feeling great and in huge need of some positive response. I think it’s really important to stop the downhill spiral of negative reaction – par example, today I got from I’m stupid to I’m an awful mother very quickly. We all make mistakes, and life is tough, we shouldn’t be so hard of ourselves. It’s cliché but remembering to be kind to yourself can save you a lot of heartache.

Accept that it’s OK to have bad days

When I follow up patients with Depression I try to explain recovery from a bout of low mood doesn’t mean every day will be better than the last. Recovery will have dips, but over time the general trajectory should be up and the dips should be less black hole-ish. I (hopefully) remember to tell people that it’s good to remember this for life after recovery. It is OK to have bad days. It’s OK to have times when you’re not 100% or you’re not ‘on it’ like yesterday. I think we have a tendency to over analyse crappy days and we catastrophise events that really don’t need the drama label. It all causes us unnecessary stress, and that is never helpful.

Accept that OK is good enough sometimes

I think it’s important to be OK with things just being OK. Now I’m exposed to the mothering world, I’ve seen another example of how people find it difficult to not be excelling all the time. I see mothers anguished by the thought of little Johnny not wearing the gillet that matches the particular outfit Aunt Suze got him, and distraught at the prospect of him missing one swimming lesson (meaning he will ofcourse fail to meet every developmental milestone for at least the next 10 years). It is OK if little Johnny doesn’t have matching socks on for nursery. It is OK if he has one meal that isn’t home cooked from your nurturing mother hands. Little Johnny will survive. And I daresay will probably turn out less weird than if we persist in stressing over the constant necessity of waitrose finest in little Johnny’s life.

Pick your battles

Sometimes OK is good enough. Alot of those times when you need to accept ‘good enough’ will be when you are very aware things could be great, but to get to great involves a lot of effort on your behalf. I’m thinking of those classic work situations. You know that improvement could be made, but is it the right battle for you to take on right now? Lots of things in our lives drain our energy without us really thinking about it. Just getting through a normal day for many of us involves a lot of mental baggage and thought processing. It’s right to take on the battles when you think they are important enough, and you have the battery reserve to do it. But fighting every battle will not end well for you.

Make time for the important and the simple things

Imagine you are 80. You are looking back over the lions share of your life. What will you smile at remembering? What will matter to you? What will you be proud of have done? I’m skating close to the cliché again, but I’m reckoning all these things will have something to do with moments with family, close friends and maybe significant career achievements. This evening my daughter wanted to read The Gruffalo. On the 3rd time of reading, I was DONE with that mouse and his persistent wood strolling. But she wanted it one more time. So we cuddled up and read it a 4th time. And that made my car crash day good again. Make time for the simple things in life. It’s what makes a life a life and not a daily trudge to the time you can watch Love Island again (Disclosure: I have definitely had days where my highlight has been watching Love Island. Shameless).

Be present

Mindfulness. One of those things you’ll have heard of, maybe given a go, decided you felt no better after it so went back to worrying about Little Johnny’s gillet. I went through a phase of trying to do some mindfulness practice regularly. But then busy-ness happens and things fall by the wayside. Like flossing. Flossing and mindfulness, both definitely on the wayside list when things are busy.

But I try to take one thing from mindfulness – I try to be present when I’m doing important things. Like being with my 4 month old. We are sharing a moment where he’s finding the squeaky giraffe-cow type rattle hilarious. I try to enjoy being in that moment rather than let my mind wander to the pile of poop stained leggings from my potty training toddler, or to the grand total of fridge contents standing at one onion and a questionable stick of celery. Yes, both of these things have happened in the last week. I am too aware that being present (including literally) for all the moments you’d like to be isn’t reality, but even when we are super busy doing this once a day should still be achieveable. Being present means you can actually experience (and therefore live) moments, rather than floating from one tesco shop to the next.

Make time to do the things you enjoy

One of the symptoms of Depression is losing interest in things you used to love. I always find this symptom very sad. Feeling like the joy has been taken from you is pretty terrible. One thing we advise patients suffering with this to do is try to keep doing the things they used to love. Because one day it’ll start coming good again. And, although Depression and struggling a bit are very, very different, I do think that too many of us let the things we enjoy go by the wayside. Another thing to add to that wayside list. What we enjoy tends to come bottom of the priority list, because of the very nature of it – it’s what we enjoy, so we see it as an indulgence that we can’t possibly flirt with now we are adults and have responsibilities like not crashing a car. But making time for things you enjoy is hugely important. Again going back to the when-you’re-80 – you’re probably not going to remember that Saturday you dusted the house particularly well. But you may remember making time to read one of the classics. Making time for yourself does not make you selfish. It makes you more robust. It makes you less likely to hit rock bottom.

Be honest

This is a real bugbear for me in this age of social media and my-life-is-so-tremendous posts. Don’t be that person. That person is rarely genuinely happy with themselves, and for some reason gets a kick out of persistent my-life-is-better-than-yours statuses. All these do is make people who feel vulnerable feel worse, and make you (as in the perpetrator of these status irritants) strive to achieve the next ‘like’, as if your very existence needs to be validated by some chuff you’ve befriended online but you see on the 5th of never. I’m not saying don’t ever share goodness, but constant updates is not good for anyone involved. No-one is ever constantly that happy. Same applies for when you catch up with friends. I know I have a tendency to want to portray the beacon of coping motherhood, but it would be more cathartic for me if I was more open about honest. Goes back to the blog on mental health and talking more. Being honest when we talk. That’s key.

Don’t isolate yourself

The honesty with friends thing leads quite nicely into this nugget. Don’t isolate yourself. Again, withdrawing from social times is a common symptoms of Depression. And again I think we can all take something from this. How many times have you had some get together planned but decided 2 hours before that it’s dark and raining and you cannot to bothered to leave the well-bedded corner of your sofa to catch up with Gazza? We’ve all done it. But how many times have you forced yourself out and rolled in from that night out proud of yourself for making the giant leap out of the comfy corner? Many, many times. I’m not suggesting you say yes to every social event (also in my opinion not a healthy thing to do), but it’s important to stay connected, see your friends and family. We rarely feel worse for being round true friends. But we can definitely feel better for it.

Radiators versus Drains

I can’t remember where I first heard it but I wish everyone knew this analogy. Some people are radiators and others are drains. Radiators are those people who shine with positivity. Drains are those people who seem to leave you feeling like all the colour of the world has been sucked out. We spend far too long worrying about supporting the drains. We worry that we have to remain faithful to that person no matter what the cost to ourselves or our mental health. Being around a drain does nothing for any of us. It’s important to choose to spend time with the people who are healthy for us and our mental health. Drains can pull you down their plug hole of coping despair.

Get outdoors

I want to make this my last point. Just recently prescribing the outdoors has become a thing in Scotland. Whilst I think it’s pretty ridiculous we’ve got to the point where ‘the outdoors’ needs to be on a prescription for some people to get outside, it really does show how disconnected we are with the world around us – and how appreciating nature can help our mental health, and help us cope better. Being outside offers so much, yet so many of us will consistently choose to spend our time shuffled away indoors. Next time you feel like you can’t cope try going for a 10 minute walk. I bet there will be a part of you that feels better for it.

Final thoughts

Today I tried to tick off a lot of these coping gems, and now I sit here and realise I don’t feel so bad. It’s still a bad day, but I’m OK with it being a bad day, and that makes it better.

So go easy on yourself, be honest about how you’re doing, see your radiator friends and family and make time for yourself and the simple things in life. You’ll cope with losing your no claims better and your 80 year old self will thank you for it.

Mental Health – more talking, less labeling?

On By doctorlunnersIn Anxiety, Depression, Doctors, GP, Healthcare, mentalhealth, NHS, overdiagnosisLeave a comment

Did anyone know that Dwayne Johnson (you know, ‘the Rock’) has suffered with Depression? Yes ok, maybe you didn’t and maybe you don’t really care (in the nicest way I’m sure). My point is the wrestler is one of a string of celebrities and high profile figures who have put aside their fame and fortune to talk about how mental health has brought them to their knees at one or more points in their life. Money can’t buy happiness and all that. If you don’t know who the Rock is, google him (but also, how do you not know who the Rock is?). Yes, money and muscles do not make you immune to the black hole of Depression.

Depression and Anxiety

I’m going to limit my mental health gambit here to Depression and anxiety. They are ofcourse epic topics in themselves, but what I mean is I’m not going into the psychotic stuff. It’ll get too complicated, and I’ll start needing to remember psychiatry terms like folie à deux. That’s French for the eagle-eyed amongst you. It’s when one person in a relationship has some delusion and the other person in the relationship jumps onboard the same delusion wagon. I nearly went into psychiatry training, but decided my brain felt far to pan-fried with all of the thinking that needs to go into therapy. I feel it’s preferable for you to not be sizzling away at 3am for your career to be sustainable.

How we actually feel

So anyway, the Rock. Let’s start by thinking about some wise Rock words – ‘You’ve got to talk about it, and you’re not alone.’ Excellent and on point, Dwayne. I’m a huge believer we are not good at recognising how we feel, and when we do, we aren’t good at really acknowledging it, and even worse at doing something about it if those feelings aren’t terrific.

Think about it. What do you feel right now? You’re automatic reaction is to almost dismiss the question as being far too simple or touchy-feely. We are used to people asking us ‘hi, how are you?’ as a passing comment as we run to our next social function. And more often than not we ask the question in a way that is geared up towards only being receptive to a positive-and-short-response. How many times have you just said ‘good’ without even thinking about it?

So, what do you feel right now? Happy? Peaceful? Helpless? Angry? Worried? Frightened? Pained? Weary? Interested? Bored? Don’t say bored, throw me a bone.

It’s hard isn’t it? Before we even talk about it, we have to recognise it. We should be able to recognise what we are feeling at any time pretty quickly but we can’t because we don’t think about it enough.

Labels – are they healthy?

Let’s take a peak at what happens further on down the line – when people are diagnosed. When it comes to having a ‘diagnosis’ of Depression and Anxiety I feel that many patients fall into one of two groups – those who want to/are happy to have that label, and those who avoid doctor lunners and her sort at all costs because they don’t want that label, thanks very much. I think the former group mostly feels it’s helpful to have a diagnosis so they are able to have a solid explanation as to why they’ve been feeling so bloody awful.

The more experience I have though, the more I think that labeling people with a diagnosis may not be entirely helpful. And I think that’s true of many conditions – I feel like we have become a bit label-happy in medicine. When we write in your records as GPs we have to ‘code’ what you’ve come in with, or what your condition is. There are some great ones. Like ‘struck by macaw, initial encounter.’ Makes you leaving wanting more that one. Did the macaw return?

Whilst I get why coding needs to happen, and there are times where having a diagnosis is helpful, I do wonder whether our need to have a label in society hasn’t been helpful in recognising and treating the depressed or anxious people who really need help. I wonder if my clinics are seeing too many of the people who are finding life tough but who aren’t actually suffering with Depression or Anxiety, and seeing too few of the people who are definitely in need of help. Let me explain before you accuse me of being an unsympathetic sod.

Berny

Berny (not real, patient confidentiality means I can’t blab about anyone. But great name right? Not enough Bernys in the world) comes in because her boss is giving her grief. She’s taken off a bit too much sick leave and they want a note for the last week of absent Berny. She has three kids and struggles with not finding time for herself. Middle child is having problems at school, and her mum who used to help her out a bit can’t at the moment because she’s broken her leg. And it’s November and it’s raining.

I cannot tell you how many times a week I see a Berny in clinic. And before you say it, I pretty much always feel for Berny. But Berny is suffering with life-being-hard syndrome, and not a mental health condition. There is a big and important difference.

The symptoms

Let’s look at the features of major depression. To be diagnosed with this you need to have had persistent low mood or loss of interest in enjoyment in things you used to love. For at least 2 weeks. This needs to be accompanied by at least three other symptoms, like feeling of worthlessness/inappropriate guilt, no energy and thoughts of death. It’s all pretty intense.

To be diagnosed with a generalised anxiety disorder (there are lots of specific other anxiety disorders, but let’s not get our complicated pants on), you need to have been excessively worrying, and finding it difficult to control that worry for at least 6 months. And other lovely stuff needs to go with this – like persistently feeling on edge, real difficulty concentrating, being irritable or easily fatigued. And there needs to be at least 4 other physical symptoms – like trembling, palpitations, feeling sick or dizzy. Again, it’s all weighty stuff.

Back to Berny

My point is Depression and Anxiety are not life-is-tough syndrome. After a particularly delightful clinic one day I had a chat with a colleague who had a standard Berny consult. When she got round to trotting out the requested sick note, she’d hit a blank. Since writing ‘Life’ down in the reason for work absence is generally frowned upon, she scribbled down a bit of low mood.

I get it, life is tough. And tougher for some more than others I’m sure. I honestly have sympathy for that. And there are definitely times where life-being-tough does tip over into Depression or Anxiety. But in my experience the vast majority of Bernys who rock up in clinic are just needing a good vent, some helpful chats on coping mechanisms, and a standard doctor rant to pass onto their employer who should not be bumping them to their doctors for a sick note for less than 7 days off work.

Unfortunately what actually happens is Berny has a tendency to end up with an inappropriate label of Depression or Anxiety, or both if she’s really lucky. Usually because her symptoms are flirting with possibly ticking off a few diagnosis boxes (some of the criteria like not sleeping has so much grey area they’re a murky winters day), she’s in clinic with same presentation for the 4th time, and her mate Bazza was put on Citalopram so please could she give those bad boys a whirl.

It is my honest opinion that this is all not helpful for Berny. She’s ended up on a drug that isn’t going to fix her social problems.

And this widespread attitude is not helpful for any of us. It is fantastic we are all talking about mental health more, that we are getting better at booting out the I’m-so-weak-for-being-human stigma. But we do not need Depression or Anxiety to be used willy nilly. It devalues using the diagnoses at all. If everyone is labelled with it, when does it all become normal? And on that note, let’s talk about how common these things are.

1 in 4 people

Dwayne said it, you are not alone. 1 in 4 people will have some sort of mental health problem every year. That is a lot of people. Whilst I do wonder if too many Bernys are included in that stat, there are also too many people still not getting the help they desperately need. I can guarantee you now that there is someone you know who you think has life sorted that is suffering from an episode of Depression or Anxiety who hasn’t cashed in on any help yet. After you’ve probably given some thought to who that lucky gem could be, let’s think about why this is.

British stiff upper lip. The old stigma chestnut. The I’m-better-than depression or anxiety. It’s odd, we apparently spend a lot of our time trying to prove our worth or prove to ourselves and others we are ‘better’ is some or all of the ways. It’s exhausting. Why do we do it to ourselves and those people we supposedly call our friends? No-one ever comes out of those conversations feeling good.

Ignoring something that is adversely affecting your daily life is not healthy, and will never end happily. Yes sure it may seem super easy to just ignore this elephant in your head rather than try to deal with it, but Nellie isn’t going anywhere. Despite having some awareness of how awful they feel, some people can’t truly admit that they may have a mental health problem. If Depression was a broken leg, we wouldn’t ignore it and crack on with the hobbling. We’d accept we need to get help. And a bit of plastering.

But Depression and Anxiety are much harder. They don’t have a bone poking out of the leg to convince you something is wrong. They involve having to recognise and admit your feelings. And then talk about them. Yes, I said it boys, you need to talk to about it. Medication can quite literally be a lifesaver in some circumstances, but I see the pills more as a life raft in stormy waters. I know, so much cheese, but it’s the best I’ve got and you’re still reading so pipe down.

The real crux of long-term help with depression and anxiety is in the talking therapies. Medication can get you to the point where you are able to face life, to feel that you’re not so consumed with low mood or worry that you cannot function day to day. But to really address the problems you need to talk it out.

Final thoughts

We all have issues. We all have beliefs that aren’t helpful. And the truth is many, many of us will suffer with a bout of depression or anxiety in our life time. And that is OK. Just like breaking your leg doesn’t make you less of a person, neither does feeling debilitated by worry. What is not ok is ignoring how you are feeling. That and asking Berny to see her GP for a sick note.

The next time you see a friend ask them how they are. In a way that is genuine and ready for a real response. You may be the help they need to figure out better coping mechanisms in our frantic lives, or you may be the person to help them get help for a debilitating mental health problem.