I was supposed to write this on Good Friday or Saturday. On the days where melancholy and lament are acceptable reflections. Delayed as I am I almost abandoned it altogether. An Easter Sunday post should be one of celebration, joy and new life. It’s true that after church today my heart feels lighter, but there’s still a heaviness within me that doesn’t change with the calendar. It may be Sunday but my heart lingers in Good Friday or Saturday. I wonder if I’m the only one.
It’s hard to ignore the pain of the Easter story, for Jesus and all who loved him. He was betrayed by a friend, arrested, ridiculed and abused. He stood trial alone and abandoned by all He loved. He suffered and died the worst death imaginable. And felt the complete separation from God that should have been ours, weighed down by all our failures.
Good Friday would have been traumatic for the disciples too. They had watched their friend taken away by an armed mob. From a distance they would have watched his humiliation, shocked and appalled. And at least some of them stood at the foot of the cross, watching the traumatic death of someone they thought was going to set them free from the Roman occupation. A man they loved and had given up everything to follow.
But it’s Easter Saturday which speaks to me this year. The adrenaline would have left the disciples system, the shock starting to drain away. The reality of the loss and the trauma would have settled heavy on their hearts. They were in pain and confused, feeling as though they had been abandoned. Their world had been turned upside down and they were left holding the threads of a future that had been seemingly ripped from their grasp. These experiences would have left behind scars, reminders of what they had witnessed which may never have faded completely.
There is much about this last year that has felt like Easter Saturday. The initial shock and adrenaline of the pandemic faded leaving behind loss and confusion. We have been left processing what has at times felt like a collective trauma. Separated from people we love and desperately want to see again. It has felt like life as we know it has been ripped away and we’re struggling to see God’s purpose in it. It’s been easy to feel isolated and abandoned, wrestling with doubts and burdened with pain.
Thinking about the Easter story again it strikes me that God could have raised Jesus from the dead straight away. Instead He waited until the third day, leaving this period of grief and mourning. Why? What was the purpose of the waiting?
I can only speculate but I wonder if it was to teach us that in this fallen world not everything will be given to us immediately. That our prayers may not be answered in our timescales. That pain and suffering is a reality that we have to live with. We will all have ‘Easter Saturday’ seasons where we are hurting and confused, waiting and hoping for a resolution we can’t yet see.
I think it’s important that the gospel allows us to see the disciples’ suffering through the lens of the resurrection. We know the story has a happy ending but they did not. And that’s often the case in our own lives. As we suffer we have no idea of the purpose in it or how long it will last. Our mourning may feel endless even when in reality we may just be in the darkness right before the dawn. The Easter story allows us to trust that there is a different perspective to our own pain. To hope that even when we are weighed down by suffering that Sunday is coming.
The mourning and pain of Easter Saturday was short-lived for the disciples. Sunday came and with it rejoicing and celebration. Jesus rose from the dead and defeated death. He made a way for us to be at peace with God. The Easter story is one of selfless love and sacrifice but also of triumph and victory.
But maybe like me your heart is still lingering in grief, pain and confusion. It’s okay if you’re celebrating today with a heavy heart. It’s okay if you’re still waiting for the sun to dawn on your Easter Sunday. You may be weighed down by a cross you’re struggling to bear even with God’s help. Your smile forced because you’re still haunted by the trauma of the ‘Good Fridays’ of your life. Maybe like the disciples on that first Easter you’re still hurting and afraid.
The joy of the resurrection may feel beyond you today but the truth of it isn’t. That Jesus suffered and died for us so that even the messiest and most painful of situations can be redeemed and restored. That He is with us even as we’re hurting and grieving, suffering and crying. We are never forgotten or abandoned no matter how alone we feel. There is no path we can walk that He doesn’t walk beside us. Even in the valley of the shadow of death.
I wish a few words could bring the dawn for all of us facing darkness today. That I could bring the sun to obliterate all the pain and sorrow of the night into glorious light. I would love to guarantee brighter tomorrows for all of us. Instead all I can offer is that if you find yourself waiting for the dawn today, know that God is there, waiting beside you. There will come a day when the darkness is only a memory. The night may feel long but the dawn will come. For all of us.
It’s been a while since I’ve written. Life at the moment is a long hard slog. It feels like surviving rather than living. Starting the day not sure how I’ll get to the end of it but attempting to put my best foot forward anyway. There’s so much noise in my head it can be hard to know what to listen to and find what’s true in amongst it all. There’s many plates in the air. In between the appointments, eating disorder recovery, chronic illness, depression, anxiety and trying to hold down a job, I worry I’m going to drop something important. And I don’t know how calamitous the smash would be.
My Psychologist said to me a few weeks ago that she thinks I’m still living my life in threat mode. Which means my brain is always perceiving danger, triggering the adrenaline-fuelled fight, flight or freeze response. She put it simply when she said it’s like there’s always a lion in the room.
And for the most part it makes sense. With a lion in the room it’s unsurprising that I’ve been struggling to concentrate. It’s understandable that my brain would not be firing on all cylinders, struggling to problem solve and process difficult thoughts and feelings. It explains the rolling anxiety that’s always churning under the surface. Why I’ve been struggling to make progress and move forward. I can see why I would feel so exhausted, struggling to sleep or rest well. And after so long like this it makes sense that life would feel unbearable and my mood painfully low.
The problem is I don’t always know what the lion in the room is. I know he prowls around hungrily every time I eat. Every meal or snack can tip me straight into crisis mode, full of anxiety and guilt. There’s definitely a part of me that’s increasingly alarmed by my changing body. Uncomfortable with the size and shape of me. The process of weight restoration and stabilising my diet has often felt overwhelming and unsafe. Maybe my eating disorder has taken the physical form of this vicious cat.
But sometimes the lion feels like Covid. He’s restless during every conversation about the virus, lockdown and vaccines. My brain has decided now is the time to panic about coronavirus, after being mainly level headed about it throughout the last year. Right now, with things opening up, I’m scared of getting the virus. Having ME isn’t considered enough of an ‘underlying condition’ by the NHS to get me the vaccine. But I worry that as someone who already developed post-viral chronic fatigue, throwing another virus into the mix could significantly exacerbate it. And with my mental health on a knife edge I’m not even sure how I would cope with the enforced isolation. The lion definitely doesn’t think I stand a chance.
And sometimes the lion seems to embody every fear or emotion that feels out of control. He can be my fear of failure, that I’ll crash and burn at work, letting everyone down. Or my insecurity, that I’m a disappointment, that I should be trying harder, doing better. Sometimes he’s depression, persistently growling about how the future is hopeless and not worth hanging on for. He can be loneliness taking on flesh and taunting me. The lion can be anything and everything all at once, big or small, mundane or extraordinary.
Even if I understand what this lion represents, what am I supposed to do with him? Am I supposed to befriend him? Do I give him a name, make up a bed and hope he doesn’t eat the cat when I’m not looking? Or can someone tell me how I kick him out the door once and for all?
The problem is the good coping strategies feel ineffective against a lion. Sure mindfulness, prayer and breathing exercises can give me a few moments peace. Maybe even send him to sleep for a bit. But you still have to keep at least one eye on a sleeping lion, as you don’t know when he’ll wake up. He’s the best behaved when I’m in motion, walking outside in the fresh air. Maybe in doing so I’m engaging in the flight response, rather than being permanently stuck in freeze mode. But, exhausted as I am, I can’t walk forever.
My besieged brain is also unhelpfully digging up more difficult things to throw into the mix. In life we’ll all encounter experiences and situations that cause pain and leave their mark on us. It might be a seemingly every day event that for us was hugely significant and affected us deeply. Or it could be moments of tragedy and disaster that turn our world upside down and cut us to our core. Both can be traumatic and leave us bruised and unsure how to move forward.
Without the right support early enough our brains can struggle to process traumatic events. And in an attempt to protect ourselves we can put these situations in a box and tie the lid shut, so we can go along with everyday life. This is what I had done with some small situations and one big one. I thought I’d processed them properly but in reality I’d done what I could on my own and then buried what remained. But the thing with therapy, and eating disorder recovery, is that it blows the lids off all these boxes. All the emotions that you’d been burying and hiding from, with the help of the eating disorder, come to the surface. And these are hard enough to deal with in normal circumstances, let alone with a lion in the room.
If someone had a magic wand and could get rid of the lion and all the difficult emotions and memories, I would take it in an instant. Right now I’m not okay, I’m not even in the same ballpark as okay. But I can’t help but think of Daniel when he was thrown into the lions den. God didn’t kill the lions or make them disappear, but he did keep their mouths shut and keep Daniel safe till morning. And as righteous and God fearing as Daniel was, he must have been terrified. He wouldn’t have been able to deny the reality of the beasts in front of him but he trusted God was bigger.
I may feel completely out of my depth but God never is. I have to trust that the God who can shut the mouths of lions will see me through this dark night and into the morning again.
Therapy can be an unsettling thing. Rather than looking at surface appearances it forces you to dig deep and unearth the roots of your issues. It can feel like it causes more pain as you have to confront those things that have been lingering in the darkness. Those weeds that have been growing up and choking you for quite some time, until you can’t tell where they end and you begin.
For me one thing that has surfaced is that I have never really liked myself. In fact dislike is too weak for the depth of disdain I feel for every aspect of who I am. There’s a hatred there that is stronger than I have ever felt for any other person or situation. Sure it has been transient in its intensity. I’ve had periods where I’ve nearly made my peace with myself, where I’ve been convinced there is some good there and the bad can be tolerated. But those spells have never lasted long, one misstep and those negative core beliefs are dug up again destroying my confidence.
I don’t remember when it started, it’s been this way as long as I can remember. The disgust I felt when I saw a photo of myself was there from a young age. My brain development shaped by the guilt I carried for everything I’d ever done wrong. There was no deep trauma or clear catalyst I can point to. I have always felt at best not good enough and at worst a fundamentally bad person.
But growing up I don’t think I was the only one. We were maybe in our early teens when me and my friends started wearing self hatred as a badge of honour. It was as though there were prizes to be won for each flaw verbalised and the speed and finality at which you rejected a compliment. We were all painfully uncomfortable in our own skin, our list of insecurities growing by the day. We had barely glimpsed the adult world and we were already emulating the low self esteem we must have seen in some of our role models.
Maybe we were supposed to have outgrown it, when the hormones faded and our teenage brains solidified. Perhaps self compassion was a lesson we were meant to have learnt at school. Sandwiched somewhere between our GCSEs and extracurricular activities. But there was no space for self love in my eight hour revision days. There was no exam for that and as such it felt unimportant.
Over the years we get better at hiding our self hatred. You learn the acceptable thing to say when someone says something positive to you. You are cautious in the negative words you let slip out of your mouth. The appropriate level of self criticism. Each day you wait for other people to open up their eyes and see you the way you truly are, which must be the way you see yourself.
Your foundations may be broken but if what you’ve built upon it is elaborate and convincing enough no one will notice. You can keep replastering over the cracks, persuade yourself all this is normal.
But it creeps out in other ways. We see it in the rubbish we accept from other people, the shapes we bend ourselves into to keep everyone happy but ourselves. Or our unwillingness to let ourselves have nice things. That reluctance to buy that thing we’ve saved up for that we know would bring so much joy. Or buying food we don’t really like because it’s cheaper and we don’t feel worthy of the extra expense. Maybe we’re volunteering for every rota to atone for all we see lacking in ourselves. We work to the brink of collapse as the needs of our colleagues and employers will always be elevated above our own. We keep beating ourselves up for our mistakes, carrying a sense of guilt that coats everything, long after our failures have been apologised for.
It’s easy to blend into the Christian world. To buy into the narrative that you are wretched and sinful, deserving of the punishment Jesus took. And be unable to grasp the seemingly contradictory truth that you’re also precious and loved by your heavenly Father. Unconditional love being for other better people than you. Your self-deprecation disguised as humility. Self-punishment as piety.
At the end of the day it doesn’t seem to matter what other people say or what you know you’re supposed to believe. We experience the world around us through the lens of what feels true. We filter information through our core beliefs no matter how negative they are. We collect information that supports them and discard that which doesn’t. I can discard heartfelt praise and encouragement and cling to criticism as though it’s gospel truth.
We can never be free when we are our own worst critic. We live our lives with the playground bully who knows just what insecurities to target. Tearing us down time and time again, until we are beaten and broken, too weary to drag ourselves up again. They will never be satisfied and we will be stuck in this endless cycle for as long as we keep listening to it.
I don’t have the answers. Even as I write this every cruel word I believe about myself still feels like absolute truth. The reality is that the roots of self hatred have been burrowing into my life for years. I am not going to unpick it overnight. But perhaps the first step is to admit it’s there and it still has a great deal of power over me. To hope that which has been learnt can be unlearnt over time. And that maybe I am worth that effort.
Today is of course Valentines Day, the day in the year where love becomes commercialised. I always greet this day with a certain amount of trepidation and this year is not exception. The last twelve months have inevitably been a challenging time to be single. Only those who have lived alone will have experienced the complete isolation that came in those first twelve weeks of lockdown when the government banned us from seeing people in real life. Many of us are bruised by that time and still battling loneliness. It would be easy to dedicate today’s post to that pain and frustration. But instead I want to write about love.
We frequently underestimate and undervalue the depth and variety of love we can share and experience as humans. Valentines Day of all days stands for me as a monument to what happens when we raise up one kind of love over another. Every advert and shop display seeming to tell us that if we do not have romantic love in our lives then we are somehow deficient. It can be easy to buy into the lie that to be single is to not experience love at all. But in that we are seriously mistaken. Love is so much bigger and richer than what is shared between a couple.
As a soon to be 30 year old single woman I can tell you little of romantic love. In the Christian world my lack of a partner or family of my own makes me an anomaly that the church at times struggles to know what to do with. This year more than ever has seen me longing for companionship. With depression it can be hard to feel loved in my heart. The part of my brain that deals with connection simply is not working the way it should. Instead love has been something I have to see. And despite my lack of a significant other this year I have seen love everywhere.
I see love in the communities who have rallied round to support those isolated and in need. The charity and local initiatives that have helped out practically picking up prescriptions, cooking meals and doing shopping. Those who have been a voice at the end of the phone or across a driveway for the vulnerable and lonely. The outpouring of generosity in fundraising and supporting the NHS.
I see love in every individual who has stayed home and sacrificed their independence for the greater good. Ordinary people who have put protecting those at risk over their own wants and desires. Shielding people they may never meet because human life is important whatever the cost.
I have witnessed so much love demonstrated to me through my friends and family. The weekly video calls connecting friends across the country reminding each other we’re not alone. The walks come rain or shine, covering every inch of our local park. The cards in the post to brighten up difficult days and the kind words from those near and far. The same empathy and understanding extended to me on day 200 as on day 1.
I see love in the health professionals I interact with on a weekly basis. Who show up to each appointment with compassion and care no matter how chaotic the world is around them. The patience to repeat the same words over and over again until they sink in. Their passion to help and support those who need them remind me to see the value within myself.
I’ve seen love in the arms of my support bubble who have welcomed me in to be one of the family. The joy of small hands in mine and seeing the world through younger more excitable eyes. The uncomplicated love of a child who takes you as you are and still sees magic in the everyday. And the friendships that feel like brothers and sisters.
I see love in the endless patience of my colleagues as I started a new job in lockdown. The words of encouragement no matter how flawed my efforts. The support and belief in me on the good days and the bad. The interest in me as a person rather than just a unit of work. The investment in the journey rather than just the destination.
One day I hope to see love in the way I treat myself. This coming year has to be one where I learn self-compassion. To try and treat myself with the same care and understanding I would show another. There’s much to unlearn and unravel to relearn differently. To look into the mirror with kindness and forgive my imperfections inside and out.
And whilst I struggle to feel and comprehend it I still see love in the arms of my God. The one who knit me together and planned all my days before they came to pass. Who sent his son to lay down his life for me and redeem every mistake and act of wilful disobedience. The Father who knows every facet of my heart and yet loves me completely.
If you’re unhappily single today it’s tempting to batten down the hatches on Valentines days and take shelter till it passes. It can feel like another celebration and life event that you’re excluded from. It’s true that a life without love can feel hollow and meaningless but love doesn’t have to be romantic to be rich and impactful. We are surrounded by so much love if we can only open our eyes to see it.
I’m going to write it here because I need the reminder as much as anyone: your life is no less significant if you’re single, divorced, separated or childless. Your worth does not come from your relationship status or family situation. Your value comes from who you are and who created you. Even if you never find a partner to share life with your life matters. You are precious and loved just as you are.
Today may see you posting mushy statuses about your significant other. Or you may be feeling sad and lonely, struggling with singleness. Either way remember that Valentines Day is only celebrating one kind of love. Lets make sure we make space to celebrate the others.
Depression is the world drained of all colour, the air heavy with foreboding. It’s looking to the future and seeing only darkness. It’s feeling a gaping, aching hole open up in the middle of your chest, sucking the life out of you. It’s a heaviness that crushes the air out of your lungs and beats your heart like a bird trying to break free. It’s sending a pale imitation of yourself out into the day. Each step like trudging through treacle.
Depression is constantly feeling the weight of other people’s expectations on your shoulders. It’s getting out of bed in the morning because they would be sad if you didn’t. It’s putting every ounce of energy into the facade of ‘being okay’, papering over all the cracks with a smile. Rating the success of your day on how close an approximation to ‘normal’ you managed.
Depression is feeling like an utter disappointment. Like every decision can never be good enough. The standards you set being always unachievable. It’s worrying your illness is a sign of a lack of faith. Constantly on alert for the next person who will tell you that if you prayed and read your bible more you’d be well. Every word confirming the narrative that this is your fault.
Depression is feeling too much and not enough all at the same time. Taking up too much space with your pain seeping out of you like a virus, threatening to infect those you love. It’s batting away all offers of help and then longing for someone to wrap you up in their arms and hold you till it passes. It’s being in so much pain but too numb to cry, the pressure behind your eyes mocking you. It’s wanting to shed your skin and be a different person. It’s writing of hope and flirting with destruction in the same breath.
Depression is not being able to watch tv as everything makes you sad. Rereading children’s books because you feel breakable like thin ice and the adult world has so many triggers. It’s staying up too late because you’re too shattered to go to bed. Having to keep busy when you’re so exhausted you could fall asleep standing. It’s starting the week with no idea how you’ll get to the end of it and when you do not being sure if to be relieved or disappointed. It’s longing for the weekend only to get there and realise it’s the last thing you want.
Depression is fighting for treatment and then feeling guilty for having it. It’s sitting in appointments as mental health professionals distill you down into a series of answers, little more than a risk assessment. It’s feeling horribly alone as people tell you you’re the first person they’ve known who felt this way. Carrying the pressure of educating on an illness that at times you barely understand yourself. It’s knowing there are places where your voice holds less weight because of your history. It’s being angry when people write you off whilst simultaneously writing yourself off. Wondering if you are worth less due to your defective brain.
Depression is always worrying if you’ve said too much whilst being scared you’ve not said enough. It’s finding six million ways of answering ‘how are you?’ without lying. It’s sometimes stumbling over simple words and other times letting them pour out unchecked. It’s constantly wondering what other people see in you whilst discarding compliments and kind words like litter.
Depression is fear. Fear of living like this. Fear of dying. Fear that you’re doing this to yourself. Fear that the sun will rise on another day and fear that it won’t. Fear of the day when the people who love you give up and walk away. Fear that happiness will always be out of reach but you’ll have to endure life anyway.
Depression is crying when you finally feel seen by a health professional. It’s months of hard work to rebuild from the ruins. It’s the day when you see a flicker of light break through the darkness. It’s the people who in hushed tones tell you they’ve been there to. Hearing that one person read some of your words and felt a little less alone. It’s the day that hope goes from being an abstract concept to something you can feel and grab hold of.
Depression is not knowing why you’re still fighting but fighting anyway. It’s choosing to show up for each tomorrow because maybe just maybe it’ll be different. It’s telling yourself that sometimes staying is the most courageous thing you can do. It’s daring to believe that your story doesn’t have to end in struggle and suffering. It’s waiting and trusting for the day when depression will be a memory that fades. When the monster under your bed packs off for good. It’s hoping maybe life can be sweeter because you’ve known such despair. That one day you’ll find all the things that depression isn’t.
***This is part two to last time’s piece, head over there for an introduction and exploration of mental health care for eating disorders. All the caveats from last time apply here too. This article will be critical of community psychiatry, based on personal experience. I do however know there are plenty of professional and compassionate psychiatrists out there.
I was first diagnosed with depression when I was seventeen years old, although it had clouded my life for much longer than that. I can remember periods of deep unhappiness as a child and lacked some the resilience my peers showed. Small things would shake my world completely. But it was easy to dismiss the heaviness that had settled on me as teenage moodiness. It was only when it became clear I was not growing out of it that I got my diagnosis.
For those who don’t know, let me pause a moment here to describe depression. Clinical depression is far more than feeling sad. It’s an invasive despair that penetrates every cell in your body. All the colour drains out of your world and just existing feels incredibly painful. It’s a sorrow that weighs you down, making everything feel heavy. Your mind becomes an alien and often hostile environment. The darkness becomes a barrier between you and the rest of the world, leading you to feel horribly alone. You forget what it felt like to feel lightness or joy.
By the point I was diagnosed had already developed an eating disorder as a coping strategy, the story of which I outlined last time. Whilst the eating disorder was treated effectively in those early years, the depression proved much harder to shift. Each of my years at university were marked by multiple depressive episodes, which were torturously hard to live through. And whilst after graduation I had more years of relatively stable mental health, depression was always lingering in the background.
Over the last ten years I have been on dozens of different antidepressants. Some I could not tolerate for more than a few weeks, others were effective for years at a time before they inexplicably failed. As I exhausted the most commonly used drugs my case would become too complicated to be treated by your standard GP. This was where psychiatrists stepped in. Psychiatrists are specialist doctors in the mental health field. They are able to prescribe rarer and riskier medications as well as in theory being able to help you access other treatments and therapies.
During those early years, whilst not all my interactions with mental health professionals were positive, I generally received competent care. I was lucky to be able to access different talking therapies including DBT, CBT and counselling. Each had some merit but none gave me the keys I needed to unlock the door once and for all. I had patches of being more acutely unwell but for the most part I was able to manage the depression and remain functional.
By the time I graduated and moved up north for work the lows were less crushing and easier to navigate. It’s true I was always looking for clouds on the horizon but I was coping reasonably well. Unfortunately when you have preexisting mental health conditions the stresses and strains of life can trigger a relapse. For me it was being in a job that had become increasingly stressful and demoralising, depleting both my confidence and emotional reserves. All it took was one stressful incident to trigger the start of my longest depressive episode to date.
As I wrote about last time, this depression and accompanying anxiety led to a relapse of an eating disorder. Eating disorders to a certain extent numb difficult emotions. They may be incredibly negative coping strategies but they are effective. As such the depression was more manageable when I was leaning into the eating disorder. But unfortunately as I weight restore and recalibrate my relationship with food, the depression is becoming more intense and harder to manage.
But this time round my relationship with community psychiatry has taken a turn for the worst. In the years since my previous encounters it seems like I have gone from being a puzzle to be solved to a problem to be shelved or pushed onto someone else. No one is expecting quick wins anymore and they do not have the time to invest in working towards the longer wins. The one thing you want from a doctor is to feel like you’re on the same team, working together to get you better. Instead I feel like an inconvenience harbouring the unrealistic expectation that they can help. Clogging up a system that does not have time for me.
As a patient I am problematic in two ways. Firstly I hope medication can make some difference. I would still like to find the medication or combination of medications that helps, even if only a small amount. I would like it to make things a little more bearable, to give therapy a fighting chance to work. But it seems my expectation is unrealistic. As my psychiatrist likes to tell me ‘you have been on so many medications’ which seems code for we’re going to give up now. I am told medication is not a long term solution, which is helpful advice to receive ten years in.
It is true that medication on its own is unlikely to solve clinical depression. It is shown to be much more effective when used alongside therapy. So little is understood about the brain and as such the psychiatric medication used to treat it. No one knows why some drugs work for some people and not for others. Many people need medication for a defined period and then recover and are able to come off it. That hasn’t been my experience. Ten years of different medications and side effects have taught me to have realistic expectations for what a medication can do. I do not expect them to fix me, all I want is for it to take the edge off the low mood.
If medication is not a long term solution then what’s the plan? Giving up is not a viable option. We have to find a way to make life manageable again.
Secondly I am problematic because my depression does not present in the way my psychiatrist expects it to. When we think of depression the stereotype is staying in bed all day, unable to care for yourself, unable to work or function. But that isn’t me. I have so called high functioning depression. I would go into work even when I’m suicidal. I am expert at putting on a mask, acting like all is well when I’m dying inside.
I know this is a privilege that I should be grateful for. I get to hold down a job and blend in with the rest of society. But it seems to also mean that when I raise the alarm, and say I’m not coping, psychiatry is not ready to listen. I can almost hear my doctor mentally ticking off the lack of warning signs that for me would not appear until it’s far too late. You’re going to work. You’ve had no hospital admissions. You can take a shower. No cause for concern,
The assumption is you will transition from high functioning to low functioning depression before there’s any danger. I wish that were the case. But we see frequently and tragically that is not always what happens. Heart breaking stories of people who went from high functioning to completing suicide. They were in work or school one day and gone the next. Loved ones going from laughing and joking with them to grieving their loss. No warning signs. No cause for alarm.
Another thing that baffles me is how little compassion I’ve encountered in community psychiatry. You meet doctors who are intelligent and knowledgeable but have seemingly no bedside manner or empathy for the patients they’re treating. What they don’t seem to grasp is that mental illness is terrifying. Your brain is wishing you harm, you barely recognise the person you’re becoming and you feel completely isolated. Each appointment, where you have to tell your darkest thoughts to little more than a stranger, is a fresh trauma. It’s a backdrop where a little kindness, compassion and care would go a long way.
I do think it’s fair to assume that the role of a community psychiatrist is becoming increasingly difficult. Not only are they short staffed with the volume of patients needing them rocketing year after year. But they also have limited tools at their disposal. They should be the gate keepers to accessing therapy and other treatment, able to help their patients get the support they need. But in reality they often have no where to send their patients who may not fit the complicated referral criteria held by other services. Out of the four referrals my psychiatrist attempted to make only one was accepted. Without the wrap around care that their patients desperately need psychiatrists are left with their prescription pads as the only tools at their disposal. Only able to prescribe the drugs they may not even believe in.
As a wrote last time I am incredibly lucky. Rather than being at the mercy of community mental health I am receiving nearly all my mental health support from a physical health service. Their competence, compassion and care is probably the only reason I’m here writing this. As my depression has worsened, and community mental health falls short, they are stepping into the gap, supporting me with any resources at their disposal. I am so incredibly grateful for them.
But there’s a part of me that questions why receiving competent care for mental illness isn’t something I can take for granted. Is it right that I could tear up right now thinking how lucky I am? An emotion born of long dark months with no support and doors shut in my face. Should getting the support you need be such a long hard journey? And what about those who depend on stretched and cracking community mental health services for all their care?
I firmly believe that when the covid physical health crisis has passed there will be a mental health crisis unlike any we’ve seen before. There are so many people who are struggling, getting by in crisis mode, who are going to crash hard when ‘normality’ returns. We’ve experienced a collective grief and trauma that many of us haven’t lived through before. Thousands of people are going to need help to process and work their way through it.
Mental health services are simply not ready for the tsunami of need that is coming their way. They are underfunded, understaffed and riddled with organisational flaws and inefficiencies. The situation seems pretty bleak.
But I didn’t call this ‘thoughts on a broken system’ because I believe there is still hope. There are many dedicated and determined mental and physical health professionals that are holding together the threads of the breaking system and catching those patients that are falling through the net. With the right support, funding and staffing these courageous professionals can build a system that adequately cares for the mentally ill using their services. Their compassion can break into the darkness of depression. Their empathy can chip away at the isolation of mental illness. Their passion can breathe hope into lives marked by despair. I believe in them.
And I believe in you. I believe in our ability as humans to rise above the suffering and struggle and overcome adversity. Maybe we can’t transform mental health services but we can all do something. We could support the amazing mental health charities that are standing in the gap for the vulnerable and desperate. Or cheer on our friends who are working tirelessly to support those with mental illness. We can continue to demand better funding and policies from our government.
We can speak hope into the lives of those who are struggling to hear its whisper above the shouting in their heads. We can check in with that friend who’s gone quiet for a while. If we’re struggling we can continue to ask for help from anyone who’ll listen, to fight to be heard and receive the care that we deserve. We can choose to keep loving people on their lowest and darkest days. It won’t always be easy, but a little love and compassion can go a long way.
***Before I start I want to make a couple of things clear. Firstly I know I am privileged to live in a country that provides free health care for all. I truly believe the National Health Service is the crowning achievement of the UK and I am immensely grateful for all the care and support I have received from it over the years.
Secondly, whilst this post will be critical of NHS mental health services, I recognise that these services are for the most part staffed by amazing people who genuinely want to do their best for their patients. They work tirelessly in services that are chronically underfunded by successive governments, and valiantly holding the cracked pieces together. I can only speak from my perspective of my decade as a patient within these services. I cannot speak from the perspective of these health professionals and will leave that to more knowledgeable voices than mine.
1 in 4 people will experience a mental health problem of some kind each year in England. Many of these people will need the support of NHS mental health services to help with their recovery. From the outside there is a perception that these services are the safety net that catch those struggling with mental ill health. We all expect that if we are brave enough to ask for help then there will always be trained health professionals on hand to walk with us through our darkest days. Most of us would profess that mental illnesses should be treated with the same care, compassion and understanding as physical illnesses. We would hope to be listened to and treated with dignity whether the problem was in our minds or the rest of our bodies.
However, I write this today because I believe the ‘safety net’ of mental health services has ever increasing holes within it. That lack of funding has led to a service that is breaking under the strain. I am not confident it is currently capable of supporting you or your loved ones through whatever challenge they face. I have seen how within the system you can become voiceless, not listened to or treated as an individual with a right to mental wellbeing. I fear that if we don’t act quickly it will be too late to save these services. And we cannot overestimate how vital they are to millions of people.
So how have I come to this opinion? To answer that I need to tell you some of my story. To avoid this post being too long, today I will focus on my experience as someone with an eating disorder. Next time I will focus on depression and community psychiatry.
I have always been an extreme perfectionist who very much likes to feel in control of life. My teenage years were clouded with what would later be diagnosed as clinical depression, which worsened the older I got. This combined with exam pressure and rejection from my first choice university, led to a level of emotional pain that my teenage brain was unable to handle. I developed the eating disorder Anorexia as a means to manage that pain.
At the time I was fortunate enough to be able to access intensive outpatient therapy to treat the eating disorder. I attended group therapy at a hospital four days a week in a nearby city. Whilst by no means perfect, the treatment was effective and after an unplanned gap year I had the tools I needed to manage my recovery on my own. It’s true my relationship with food never went completely back to normal, but for the most part for nearly the next decade I considered myself recovered from Anorexia. Although the depression and character traits that triggered the first episode were still very much present.
All this changed in November 2018 when a stressful incident at work triggered me to develop anxiety and worsened my pre-existing depression. I took two months off work to attempt to stabilise my mental health but unfortunately it did not undo the damage. I valiantly and perhaps naively returned to the same stressful job. But the pressure and strain of attempting to do a job I was no longer emotionally equipped for triggered a relapse of the same eating disorder I had fought as a teenager.
The thing about relapse is you know early on that you’re in trouble. I was out of my depth before the weight loss even started. All the research says the key thing is to access help as soon as possible and so early on I talked to my GP about my history and my current struggles. What I learnt was that in my area, as in many others across the country, eating disorder referrals are based solely on weight. In short I was not thin enough to get the professional help I needed to get back on track.
Let’s stop here a minute and consider this one. Eating disorders like Anorexia are complex mental illnesses with a wide variety of symptoms. It is true that a low BMI can be a hallmark of Anorexia but it is by no means the case for everyone. There is in fact a whole category of ‘Atypical Anorexia’ where sufferers do not exhibit a low body weight.
An arbitrary BMI measure also does not reflect how far from their normal BMI someone’s weight has fallen. The healthy BMI range is between 18.5 and 25. If you took for example a BMI of 17 as your measure for underweight this could mean a fall of only 1.5 BMI points in some cases and a fall of 8 points or more in others. A person’s BMI not only does not tell you the severity of the hidden mental illness they are battling in their minds, but it also does not paint a full picture of the state of their heart and other vital organs. Restricting your diet is dangerous whatever weight you are at.
Thanks to the persistence and connections my GP had, we managed to get the go ahead to make a referral to the eating disorder service despite my weight being above the referral criteria. I was hopeful that I could get support to get this under control before things got serious. And then COVID hit. As with many NHS services, staff were reassigned from my local eating disorder service. Rather than see their waiting lists lengthen a decision was taken to make it harder to get a referral. They dropped the maximum BMI you could have to access their service, with Anorexia, from 17 to 15.
I waited around five months for news before my referral was rejected with a few sentences of an email. I was devastated. With the anxiety and social isolation that had characterised lockdown I was becoming more unwell with each passing week.
Again the dedication and commitment of my GPs came into play. They essentially messaged any contacts that they had who might have or know of someone with eating disorder experience. They were able to find a psychologist and dietitian who did private eating disorder work and were connected to a non mental health NHS service. They were prepared to do an assessment but opened by saying it was very unlikely they’d be able to offer ongoing support. The assessment was intense and emotionally exhausting. I went through it not knowing if even after jumping through all these hurdles I would be able to access any ongoing support.
This was where things came together in a way that had God’s fingerprints all over it. It transpired that these professionals were attached to the Chronic Fatigue Service. As I’ve written about before I also have a diagnosis of ME/Chronic Fatigue Syndrome. This meant I was able to get in through the back door, be admitted to their service where they would then treat the Eating Disorder alongside the Chronic Fatigue.
So I find myself in the rare situation of receiving nearly all my support for a mental illness from a non mental health service. I think in many ways I am receiving better support than I would be if my original eating disorder referral had been accepted. I have a dietitian I get on really well with and get to see fortnightly. Rather than setting an arbitrary meal plan she is taking a tailored approach to bring my diet back to a healthy and balanced level. I am supported weekly by an assistant psychologist to help me develop coping strategies and skills to manage the difficult emotions that are inevitably coming up. And in a few weeks time I should start work with the psychologist to try and unpick the threads that have got me to this place.
So, as it seems I’ve landed in my feet, why am I writing this? Because simply put I came perilously close to getting no support at all. Without both the perseverance of my GP and my CFS diagnosis I am not sure where I’d be now. As it was by the time I started receiving support I had dropped 6 BMI points below what was healthy for me and lost nearly 30% of my body weight. If I had lost any more weight I would have been too ill to be treated in the community. Inevitably a further delay would have left me at a dangerously low weight and more than likely in need of a hospital admission before the eating disorder service would have stepped in.
Asking for help when you’re struggling with an eating disorder is very difficult. You are fighting against the voice in your head that is telling you that you don’t deserve help or recovery. When your plea for help is rejected it reinforces this harmful belief. There is no guarantee that person will ask for help again. Anorexia has the highest mortality rate of any mental illness. Without help there is likely to be a tragic end to many stories.
I also do not know how different my story would be if I could have accessed help when I first noticed I was relapsing. It’s likely recovery would have been much quicker and easier if we could have caught it before it deteriorated. As it is I am still finding recovery incredibly difficult and painfully hard. I wish I could have avoided some of this pain.
I am writing this because unless you’ve personal experience you will likely be blissfully ignorant to how many hoops we make mentally ill people jump through. It’s easy to read the tragic stories of lives lost to eating disorders and think ‘if only they’d asked for help’. When in truth many of them did and were completely let down by the system. I know I am immensely lucky not to be one of them. Many of us struggling with these illnesses do not have a voice and can be easily dismissed as unreliable or unstable. We need you to speak up for us.
We need to demand better from our mental health services. They desperately need the funding to cope with the ever increasing number of people needing them. We need to support the mental health professionals desperately trying to plug the gaps in the system. We need to treat eating disorders earlier, before the damage to physical health becomes irreversible and the disordered thoughts so insidious that it’s impossible to root them out of the mind. Vulnerable people deserve better.
In the UK we are in the midst of a third national coronavirus lockdown. I think we all knew the announcement was coming, having watched the number of cases rise day after day. But somehow, expected or not, the news and the fear and anxiety that comes with it, can still knock us for six.
Parents across the country are again having to madly juggle home schooling alongside work and other responsibilities. The clinically vulnerable find themselves again confined to the walls of their homes. And all of us face a narrowing of our lives as socialising is discouraged and we’re told to stay home for the foreseeable future.
Whilst I may not agree with all the decisions made along the way, given where we find ourselves now, I appreciate the government had no option but to declare a lockdown. However, as I read the guidelines I became increasingly frustrated, mainly for what was missing. Despite the dozens of sections included in the main guidelines next to nothing has been included about mental health. There is no guidance on what to do if you find yourself in a mental health crisis.
Reading between the lines it looks like you can interpret needing to leave home ‘to avoid injury or illness or escape risk of harm’ or ‘to provide care’ as applying to mental illness as much as physical illness. But navigating these grey areas is something that is very hard to do when you’re in poor mental health.
It feels like over the last twelve months we have had to sacrifice our mental health on the alter of our physical health time and time again. In the grip of such a deadly virus it’s understandable that the priority has been to stop the spread at any cost. Concessions to support mental health have been an after thought, if they’ve come at all. It feels like the government are hoping that if they don’t talk about mental illness then it won’t be happening to millions of people across the country.
My frustration now is a product of the last nine months. I am angry that it took the government twelve weeks to realise how essential support bubbles could be for those living on their own. Twelve weeks where we were not allowed to see anyone in real life, stealing illicit conversations with those you ran into in the park. Infuriated at the article I read that said suicidal people should go to A&E rather than take the risk of talking to a friend across a driveway. I’ve been fearful as I’ve watched staff being reassigned from already stretched mental health services. I’ve felt the impact of an eating disorder service tightening their referral criteria meaning they will have denied hundreds of people the support they desperately needed.
It’s right that we make sacrifices to prevent needless deaths from this horrible virus. But we don’t seem to be recognising that the people paying the highest price are those least able to afford it. That for some isolation is more deadly than coronavirus. There will be people who have lost their battle with mental illness over the last year. I am lucky not to be one of them. Some of those deaths could have been avoided. The shame and stigma surrounding them will mean there will be no minutes silence to remember. Their tragedy may not make the headlines. But their lives are just as precious as the heroes dying in our frontline services.
Mental health services are already falling apart. It is too late to just throw money at them. They can not cope with the tsunami of support that will be needed when people come out of crisis mode and realise how far they have fallen. Without support they may be unable to put the pieces back together.
For many fear and anxiety are now burned into our souls. Teenagers who have known loneliness and isolation too young. Adults who’ve watched their support network crumble. The elderly who have been prevented from cherishing the twilight years of their life. Many who have felt the darkness of mental illness overtake them as their homes have become prisons.
I am fully aware that I am biased by my own experiences. I am writing this with a war still raging in my mind, absolutely scraping the barrel of energy and strength available to fight it. No one else can do it for me. I can send a friend to pick up my prescription but they can’t eat my snack for me. Nor can they see off depression for me when it suffocates me in the dark.
To have mental illness is to battle daily for the right to a normal life that many will take for granted. You are fighting shadows that no one else can see and as such you largely fight alone. There is no respite and at times you are reliant on the hope held out to you by others. Sometimes the connections you feel to other people can be the fragile threads that tie you to life. Isolation is deadly.
I am not saying for a minute that you shouldn’t follow the government guidelines. But what I am saying, to me as well as to you, is that your mental health is not an optional extra in this lockdown. It is essential that you nurture and protect it just as you safeguard your physical self from catching this virus. Mental health can be broken quickly, but trust me when I say, it is much harder to rebuild again.
And as the government won’t explicitly say it, I will say it here: you can break lockdown if you’re in a mental health crisis. If you cannot keep yourself safe not only are you allowed to seek support from a friend, loved one or health professional but you should do so. If staying at home will result in harm to yourself then please go to somewhere where you feel safe. Mental health crisis services are still running and you should be able to find the number of the local NHS crisis team for your area. Failing that in the UK ‘Samaritans’ are there to listen 24/7 by phoning 116 123. If phone calls are hard ‘Shout’ offer a texting service you can access by sending ‘SHOUT’ to 85258.
I won’t pretend there won’t be difficult days ahead for us. But whatever happens know that you are more than the battles you’re facing. You are precious, valued and loved. The world is a better place because you’re in it. No matter what the darkness tries to say you are never alone. Keep reaching out for the help and support you deserve. There will be brighter days to come. Even the darkest night must end with the dawn.
It would be easy to round off this year with a reflection on how awful a year it has been. But given that no one has got through 2020 unscathed, I don’t think it needs saying. None of us could have predicted where this year would take us, how far our normality would shift, the new words that would enter our vocabulary, the temporary highs and crushing lows.
But whilst 2020 is the year I want to forget, it’s been full of people I want to remember. People who have made an impossible year bearable. And this post is for them.
Here’s to the friends who have loved me from near and afar. For all those who’ve shared countless walks, in every weather imaginable. Those who have always been at the end of the phone or a video call. To the work friends who have helped me through many a lunch. To those who haven’t known what to say and so have listened with love, patience and compassion. Making space for me in their lives despite the challenges of their own they face. For those who will always believe I have something to offer to tomorrow, and hold out hope for me when I’ve lost sight of it myself.
Here’s to my family who have been stuck hundreds of miles away, as my world decreased to the radius of a few miles I could walk to. But who I know without a seconds thought would hit the motorway and come and scoop me up if I asked them to. It’s not easy to love someone with mental illness and you have loved me longest.
Here’s to my support bubble who welcomed me into their home and their lives. Thank you for all the love, hugs, meals and distractions from everything going on inside and around me. My heart lifts as soon as those precious little ones greet me with cries of ‘Auntie Sarah’ when I walk through the door. Thank you for being family to me and showing me God’s love when I can’t feel him myself.
Here’s to all those who worked so hard so that our office could reopen to those of us who needed it. Never would I have predicted what a lifeline it would be to be able to work in the same room as other people. I used to aspire to the working from home life, but it was much harder than I could have envisioned. Now my desk is my haven, I walk through the doors and know that as long as I stay there I am not alone. On the weeks where isolation has sunk into my bones this means more than I can put into words.
Here’s to my amazing work colleagues from my old job and new. All those who have cheered me on, especially on those days I felt like I was failing at everything. Who continue to believe in me when I don’t believe in myself. Here’s to the managers who have welcomed a more fragile and vulnerable version of myself than any of us were expecting. Who support me in making the best out of the cards I’ve been dealt right now. Who do not hold my mental health against me. You are worth your weight in gold.
Here’s to the medical professionals who continue to scrape me off the floor and remind me recovery is possible. Who help me unravel the ropes I’ve been tangled up in, listening without judgment and speaking truth whether or not my besieged brain can absorb it. I don’t think I would be writing this now without them.
Here’s to all the church leaders and volunteers who have had to reimagine what church looks like. For all the hours that have gone into creating the procedures needed to reopen the doors and keep everyone safe. For the endless days creating online content so we can feel connected to church communities even when the doors are closed and the streets empty. You work so hard behind the scenes whilst juggling your own difficulties and responsibilities.
Here’s to the key workers who have kept shelves stocked, brought deliveries and cared for the sick and vulnerable. All those who somehow still find a smile despite the exhaustion and constant hurdles to overcome. You are ordinary people doing extraordinary things with minimal pay and recognition. You deserve to be paid and supported in more than just claps.
Here’s to the creatives who have kept us stocked in music and entertainment, bringing much needed expression and laughter into 2020. I teared up through the opening sequence of ‘The Great British Bake Off’ as it served up a slice of normality back into my alien life. Never before have we been more in need of places our minds can escape to.
Here’s to the encouragers who with a well placed email or message have reminded me I am stronger than I think, loved and believed in. You don’t know how much your words mean. Please keep them coming, they can be the threads that tie me to a life that can threaten to float out of my grasp.
Here’s to my beautiful feline friend who came to me just a few short days before the world imploded and has been more or less asleep on my lap ever since. She was the answer to a prayer I didn’t know I needed to pray. It seems silly but having something to come home to makes a big difference in a year where I have spent so much time alone. She has sat with me as I sobbed. When she rests her head on my shoulder and lets me wrap my arms around her, it may not quite be a hug, but it’s somewhere close.
Here’s to a God who I know is still there even though I find it so hard to hear him. Who I know has been moving mountains behind the scenes to get me the professional help I needed. Who continually puts people in my path I can lean on. This year has stretched my faith to its limits but I’m still holding on.
And here’s to you, wherever you’re reading this. You’ve fought your way through seemingly impossible days. You’ve ridden the waves of uncertainty and anxiety. You’ve had to reinvent your lives in this strange new world. You’ve learnt to hope amidst the grief and made countless sacrifices for the greater good. You are precious and loved. The world is a better place with you in it.
On paper 2020 should have defeated me. On my own it may well have done. But it takes a village to survive a pandemic. So let’s raise a glass to those people who have got us through.
Here we are at another Christmas. Although this will be the weirdest one that most of us can remember. So many if us are separated from people we love, facing a season full of rules and restrictions. Trying to find a way to celebrate, when 2020 has drained most of the joy out of us. We are weary of the disappointments, the griefs and pain of such year. We want to look forward with hope into the new year but we’re wary of being let down again.
With everything that’s happening it’s easy to feel, even as Christians, that Christmas has been cancelled. So much of what we enjoy about Christmas has been taken away from us. It’s okay to feel upset, frustrated and disappointed. It’s true that no pandemic can truly prevent us celebrating Jesus’ birth, which is the true meaning of Christmas. But nonetheless we are left with a sense of loss.
2020 has been a year of waiting. Waiting to see and embrace loved ones again. Waiting to see life return to some kind of normality. Waiting to find out what will be left and what will be washed away by the storms of this year. Waiting for an end to the constant anxiety and endless stream of bad news.
I wonder if, in this unusual Christmas, we are experiencing something close to what that first Christmas must have felt like. The census had displaced all the Jewish people, scattering them to ancestral towns that they may not have even visited before. The isolation Mary must have felt arriving in a strange town, with Joseph, her soon to be husband, who at that point was likely to be little more than a stranger to her. She gave birth away from her family and friends. She must have felt lonely, confused and scared. You wouldn’t have blamed her for wondering why God’s plan came at such great personal cost.
The Christmas story is also full of tales of people waiting. From the Israelites who waited hundreds of years for the prophesies to come true and the long awaited Messiah to arrive. To Mary waiting nine months for God’s plan to come to fruition. Even Jesus was born into decades of waiting as it took 30 years for his ministry to begin.
But one person I’ve been most struck by as I revisited the scriptures this year is the story of Elizabeth, Mary’s cousin who became the mother of John the Baptist. Elizabeth and Zechariah had spent many years waiting and hoping for a baby. Each passing month would have brought with it crushing disappointment as there was no pregnancy. Not only would they have faced the personal heartache but also the stigmatisation and ostracism by their community, who would have viewed their barrenness as a sign of their sin. They must have felt alone and abandoned by God.
And yet into this pain and confusion God steps in, promising that even in their old age they would have a son. It’s hard to blame Zechariah for questioning the angel who brought the news, wanting some kind of proof. When Elizabeth found out she was pregnant she hid herself away for five months. And I can’t help but wonder why.
Did she want to keep the joy to herself before she had to share it with other people? Was she scared that she could come this far, only for it to be snatched away again? Did she fear the reactions of others? There is something so human and relatable in that five month wait. Even the mother of the last prophet needed time to process all that was happening.
I suppose what I’m trying to say is that within the Christmas story there is space for all the emotions we are experiencing. Be it fear, disappointment, grief, heartache, joy, celebration and love. There is space for us to wait and hop for better days whilst feeling the pain and hurt of these experiences.
We are invited to come and sit round the manger whatever burdens we’re carrying and emotions we’re feeling. There’s a place for us there no matter what 2020 has held for us. Jesus was born into the mess and chaos of humanity. He came so that wherever our journey leads us we would never walk it alone. He is Immanuel, God with us. And we need him now more than ever.
