CBT didn't work for me. Why am I made to feel guilty and ashamed?

Cognitive Behavioural Therapy (CBT) is one of the main types of therapy available to those suffering from mental illness. It is supposed to work by changing the way you think and behave in response to external events. You are taught to identify negative thought patterns, weigh up the evidence for these thoughts objectively and come up with more balanced thoughts. By doing this, you are supposed to be able to change the way you feel and behave.

I’ve tried CBT a number of times: twice with two different therapists every week for a year and once in a group for 20 weeks. I definitely think that therapy should be explored and would advise anyone with a mental illness to give it a go. However, with CBT, I found that it didn’t made me feel any better and at times it has actually made me feel worse. I don’t wish to diminish the help it may give to other people, but for myself, I have found it lacking.

When I read about CBT it sounds like it is based on good common sense. Your thoughts, feelings and actions are certainly connected. The idea behind CBT is that by changing one of these (your thoughts) you change the rest. One of the problems I have had with CBT is that my thoughts are so ingrained that they have proved impossible to change. Most thoughts that we have are automatic. We are not always aware of where they come from, they just appear. Changing these is an uphill task. I found it impossible to change these thoughts once they had already ‘lit up’ in my brain. 

CBT teaches you to assess your thoughts and come up with more balanced thoughts. When I did this however, I found that although I could easily come up with the more balanced thoughts, I didn’t really *believe* them. I found myself in the strange situation of having a balanced thought and an ingrained, unbalanced thought fighting with each other in my mind. For me, CBT created a situation where I believed two contradictory things and this caused me quite a lot of stress. The more the negative thought popped up in the brain, the more I punished myself for thinking it and the more stressed I became.

In doing CBT, I was aware of what thoughts were more balanced but it still didn’t change the way I felt or the way I behaved. Perhaps this was due to the cognitive dissonance happening in my brain. Maybe other people are able to hold on to the balanced thought whilst discarding the unbalanced, automatic thought and so their feelings and behaviours change. But for me, this never happened.

One potential problem with CBT is that you don’t know which comes first, the automatic thought or the feeling. CBT seems to be based on the idea that it is the thought which originally causes the feeling which, in turn, causes the behaviour. However, I find that I often feel distressed, depressed or anxious for no good reason and that this then causes me to start having negative thoughts. Changing the thought then won’t necessarily cause a change in the feeling if the causal relation is the other way around. 

One of the difficulties I had with CBT is that I was made to feel guilty for my feelings and behaviours. I kept being told that my unbalanced thoughts were causing my illness and this made me feel ashamed. Thoughts seem like something you should have control over so I was sometimes made to feel like it was my lack of control over my own mind that was leading to my illness. 

It seems to me that it is fairly controversial to say that a certain therapy wasn’t helpful. I found that when I attended CBT, the therapists believed in it so strongly that I wasn’t able to say that I didn’t think it was helping. When I filled in forms before and after therapy that assessed how I was feeling, they made lots of excuses for why I wasn’t feeling better. There was no allowance that CBT may not be effective for everyone.

If you don’t find a certain therapy helpful and express this opinion, you are often treated like you just aren’t trying hard enough. You feel like a failure for not being able to take control of your life and fix your mental health problems. The reality is that I am trying really hard every day. I try and eat healthily, take long baths, go on walks, listen to relaxation CDs and take medications with horrible side effects. I don’t *enjoy* doing any of these things and I am not even sure if any of them are effective but I give them a go because I am told that they work and I want so badly to feel normal. 

CBT may be effective for some people and I am glad that it is available for people to try (although of course many people have to wait months to receive treatment on the NHS and it is often a short course with not enough allocated time). I think that it is good practice to try and become aware of your thoughts and see how they might not be accurate. However, personally as a therapy I found it didn’t help cure my mental illness. In fact I felt guilty and ashamed as a result and was made to feel like I wasn’t trying hard enough. Therapists should always be aware that some therapies don’t suit everyone and that this is no reason to judge someone for not getting better.We are all trying our hardest. No one chooses to be unwell.

Even mental health professionals can display stigmatising attitudes

Lots of people with mental illness experience stigma in their everyday lives. Perhaps your parents think you should be able to pull yourself together and think yourself out of your problem. Perhaps your friends believe that you have control over your illness and could do more to help yourself. If only you would join an exercise class or start eating blueberries or something, everything would get better for you.

I have come to expect these sorts of sentiments from people. Sometimes it comes from a good, albeit misinformed, place. Your loved ones are often just trying to help you with something they don’t understand. This doesn’t make it any easier to hear though when you know that you are trying your hardest and nothing seems to work.

I find myself trying to do the things that people want me to do just so that I can say to them: ‘look I have tried X and I'm doing all I can to try and get better’. Ultimately though, I know that these things won’t magically cure my mental illness. It’s more complex than that. My body has shut down and my behaviours have become strange. A switch has turned off in my brain and it is going to take a lot more than going on a jog to fix things.

Hearing these kinds of things from friends and family is to be expected. Hearing them from professionals though is quite shocking.

I once went to the GP to ask for some diazepam for my anxiety problem. I had been prescribed it by my psychiatrist but I wasn’t seeing him for a while. The GP’s response? ‘You just need to WORK through your anxiety. You shouldn’t rely on medication.’ (tone was very dismissive). I felt like I was being blamed for my illness. If only I would work a little harder, all would be fixed. I was made to feel like I was taking the easy road by taking medication. Of course, if medication is the easy road so be it. I would rather take the easy road and fix the problem than struggle down the path of yoga and raw vegetables alone.*

Maybe you wouldn’t expect a GP to have an in-depth knowledge of mental health problems. However, I would expect that a mental health support worker would have this kind of expertise. I had a very bad experience with my support worker. She forced me to do things I wasn’t ready for, she made me pay for her parking that she claimed back anyway and she asked me to buy her presents on my holiday. What most distressed me though was that she knew that I had bipolar but she didn’t believe it. When she read through my DLA application she was really shocked by the description of some of my behaviours. Her attitude? ‘I have never SEEN you behave like that.’ (strongly accusing tone). Surely as a MH support worker she would be aware that people cover up their problems.

Another time I attended an anxiety and depression group. The woman that ran the group said to us right at the outset: ‘I don’t think that any of you are ill. Mental health problems are down to bad experiences, but you are NOT ill and do NOT need medication.’ Now I am not of the opinion that only medication should be used to treat mental illness. Tools such as relaxation, CBT and mindfulness are all things that may help some people with mental illness. But dismissing the idea that mental illness should be treated with medication is dangerous. Medication helps many people and has been shown to be effective in controlled clinical trials. It is not good practice for a psychologist to dismiss medication just as it is not good practice for a psychiatrist to dismiss psychological treatments. Ultimately  of course it is a patient’s choice what methods of treatment he or she uses.

When a mental health professional says these kinds of things it’s very distressing for the patient. Anyone who has experienced a mental illness knows that they cannot control the illness by will alone. It is not a problem with strength of mind or character. It is not an easy choice to take medication. We have all experienced the side effects and the feeling that you should have been able to control the situation yourself without intervention. The fact that so many professionals have these incorrect assumptions about mental illness is deeply concerning. However, they just reflect the deeply ingrained prejudice of society in general.

A mental health professional has an important relationship with the patient. It is one in which the power dynamic is unequal. The patient is deeply distressed and desperate for help. They are fully reliant on the mental health professional for help. Most professionals are aware of this power imbalance but do everything they can to listen to the patient and advise, not dictate to them possible treatments. However, a significant minority of professionals give poor advice and demonstrate the same prejudices that uninformed members of the public have. This is all the more damaging considering the power imbalance between patient and professional.

Over the past few decades we have come a long way in tackling mental health stigma. This is partly because many professionals have gone out of their way to educate people and remove some of the stigma. I do not wish to negate some of the wonderful work many professionals do. I would not be where I am today without some of the great help I have received. However we must still hold those in power to account. When a professional holds a prejudiced view they need to be challenged, because often it is all the more damaging coming from them than it is coming from your friends and family.

 

 

 

*This is not to dismiss lifestyle changes. My point is that there are many treatments available to us.

Review of 'Being Bipolar' the Channel 4 documentary

I didn’t have high hopes for ‘Being Bipolar’, the latest Channel 4 documentary. I worried that the footage would be upsetting. It is always difficult to see other people struggle with mental illness in such a similar way to yourself. What I was most concerned about was the way that the documentary might portray those with mental illness. The media often don’t portray mental illness in an accurate sensitive way. This documentary was no exception.

It started with the host of the show, a psychotherapist called Phillipa Perry, pointing out that the established belief is that bipolar disorder can be caused by a variety of factors including chemical imbalances, genetics and environment. However, for some reason she started out the programme with the assumption that bipolar is caused solely by life experiences. There is no evidence cited to back up this belief, but it is a belief she holds on to.

She interviewed three different people who have bipolar disorder. She displayed sympathy and kindness to those people but in approaching them with her dogmatic belief, she couldn’t help but undermine them.

She repeatedly asked them if there had been any trauma in their life, to which the answer seemed to be a resounding no. Phillipa Perry saw any negative experience as a complete explanation of why someone developed bipolar disorder. At one point she cited how one of those people interviewed, Paul, had been an only child and then a successful business man later in life. As if this somehow explained away everything.

There are of course certain experiences that everyone has that have been traumatic and these people interviewed will have had these kinds of experiences too. This doesn’t instantly mean that these experiences have caused bipolar disorder to develop. If they have they are likely to be part of a complex picture that includes environmental, genetic and chemical factors. Stressful experiences may trigger episodes, but it seems that some people have a propensity towards the illness to begin with.

Phillipa Perry talked very negatively about medication used to treat bipolar. She declared that people with bipolar disorder were using medications to numb emotions and that this was only a temporary fix. In one fell swoop, she made thousands of people feel ashamed that they rely on medication. Of course, medical professionals generally agree that medication is important in the treatment of bipolar disorder. People take medication because they are desperate to get help and the effectiveness of certain medications are backed by clinical studies. This generally held expert belief didn’t seem to matter to the presenter who pushed psychotherapy as the appropriate treatment. This is not to say that psychotherapy can’t used to treat bipolar. It’s just that this isn’t the only option out there; a range of treatment options should be considered for bipolar disorder.*

I fear that people will watch this documentary and then think that they know everything there is to know about bipolar. I fear that people who don’t know better will judge me for being on medication. I fear that because they have seen people interviewed with the illness, they will think that my experience is exactly the same.

I know that these kinds of programmes are important in raising awareness, but that is not much good if the awareness they are raising is misguided awareness. I hope that people will come away from the documentary with sympathy for those interviewed but remain sceptical about some of the presenter’s opinions. 

*Of course, psychotherapy is barely available within the NHS, Medication is a lot cheaper to provide and so is often the go to for mental illness for this reason too. 

How will my friends react to my mental illness?

I wage a constant battle with myself. It all revolves around what my friends will think of me. Should I hide my mental illness from my friends to avoid embarrassment? Or do I drop the mask and allow friends to see me acting abnormally, knowing that some people will be scared and judge me harshly?

Having a mental illness is no fun, but it’s made all the worse by the stigma which surrounds it. We can’t help but be affected by society’s expectations. Everyone cares what other people think of them. The fact is that society judges those with mental illness negatively. 

Often people think that those with mental illness are responsible for their condition. The idea is that those with mental illness are somehow in control of the course of their illness and can choose whether or not to succumb to it. Often it is thought that those that have mental health problems are weak in some way. Perhaps other people suffer from the same problems in life but are of strong enough mind to overcome their difficulties. On this view, whether or not you suffer from a mental illness is all about choice.

Some people may go a step further and think that mental illness doesn’t even exist. You can’t see a mental illness, only observe behaviour. The behaviour can seem strange and scary. It is easier to believe that someone is just ‘crazy’ (a dehumanising word, setting someone apart from yourself and others) rather than imagine that person to be just like you or me but in intense mental pain. Some may just think that the person is behaving this way because they have let themselves go rather than actually suffering from a medical condition. 

These kinds of thoughts often lead people to the belief that those with mental health problems are a drain on the state. They read about ‘benefit scroungers’ in the newspapers and believe that someone with a mental illness is unworthy of help. At best, they are weak and lazy. At worst, they are faking it for monetary gain. Either way they see you as a drain on ‘the taxpayer’.

I worry that my friends will be thinking these kinds of things about me when I talk about my mental illness. I don’t think most of them will think I am making it up, but perhaps they think I am lazy and a drain on the state. I claim disability living allowance but I don’t tell many people that. I am sure they can guess though. Maybe they look at me buy new things or go on holiday and resent me for it. Who knows what kinds of things people are thinking when they look at me. I shouldn’t care. Mental illness is not about weakness or choice. I should just shrug it off. They are the ones with the problem with their ignorant views. I shouldn’t care, but I do.

I try to navigate the tricky path with how to behave around other people so as to minimise these kinds of negative judgements. I want to be open and show people what my mental illness really is all about. I want to tell people about the way that I feel and why I end up behaving as I do. Most of my friends know that I have a mental illness. However, I always end up trying to hide the behaviours associated with it to avoid people thinking I am scary or weird. If I am depressed, I act cheery. If I am anxious, I act much more calmly that I feel. If I am manic, I try exceptionally hard to quash down my desires to pace around and laugh wildly.

I have ended up in the strange situation of being open in what I say about my mental illness but acting as if nothing is wrong. Of course, in doing all this behaviour modification, people are going to have a hard time believing that I am really ill. I may have saved face but people are going to wonder why I can’t work when I seem capable enough in front of them. 

I know that other people with mental health problems must feel the same way. As well as coping with the illness, we have to deal with the stigma surrounding it. This makes it hard to be completely honest and open with people. However, how are people ever going to understand mental health problems if we all keep quiet about it? It is a tough dilemma because when we are open, we sometimes do get judged negatively by people we think of as friends. We can only hope that real friends will at least try and be compassionate, even if they don’t really understand mental illness. 

A day in the life of just one person with mental illness #adayinthelifeMH

A Day in the Life (https://dayinthelifemh.org.uk/) is a project which aims to collect the everyday experiences of people who have mental health problems. The project is collecting accounts from mental health sufferers on four particular dates over the year. What follows below is my entry of what happened on Tuesday 10^th of February 2015. I hope that you can take more time to read the other entries on the project website, coming soon!

My day starts differently to most days. Due to a combination of depressive symptoms and heavily sedating anti-psychotic medication, I usually manage at least twelve hours sleep. However today I am up at 7.30am. The reason for this early start is that my house is getting surveyed and I am too scared to be around whilst a stranger is there. I have a lot of problems with social anxiety, so interacting with a stranger is extremely hard for me. What will I say? What will they think of me?

My plan for today is more or less the plan for every day: My partner drops me off at my parent’s house to spend the day with them. My Dad works from home and my Mum works part time so I have someone with me all the time. I lost a lot of confidence because of the panic attacks I have been having over the past year. I think everything through over and over and panic that all sorts of things may happen. I feel safe with my family and so I am always with them. I just can’t be on my own anymore.

Today was a day that my Mum was off work so we did a few boring things like go shopping for a washing machine. I had to talk to someone at the shop which filled me with dread but I managed ok. I am hoping that as I keep taking small steps to combat my fears, they will eventually go away. We then went for coffee. I have to say that going for coffee with my Mum is (sadly) one of the highlights of the week. When you live life with a mental illness, the smallest things can really make your day. When I visit a coffee shop I can sit in the corner where no one will notice me and watch what goes on around me. Having a coffee feels a little bit special for some reason.

Later on in the day, I start to get excited for no particular reason. I have bipolar disorder and sometimes my moods go all over the place. On this particular day, I feel high for a few minutes and jump up and down laughing but then I crash back into depression just as quickly. I feel tired, lethargic and useless.

I get picked up by my partner in the evening and I manage to make dinner for once. Cooking can be hard when you don’t have any energy or motivation. Luckily I don’t have to do much. We have crispy duck with pancakes and hoisin sauce. All I have to do is chop the veg and put the duck in the oven. It isn’t good for my weight, which has soared since going on the anti-psychotics, but it is so comforting to eat fatty food that I find it hard to care!

My partner goes off to an exercise class in the evening, leaving me at home. The evenings are the hardest for me as they are when I get most anxious and am also most likely to have bipolar symptoms. I am practicing being alone for short periods to try and overcome my fear of being alone. I can feel the panic rise in me but I try and distract myself by looking up things obsessively online. I search all sorts of random things just to keep my mind occupied.

I go to sleep with my partner reading next to me. This is the deal we have made. He reads and looks out for me as I drift off to sleep. I feel safer that way with the light on. Luckily sleep doesn’t often elude me because I am zonked out from the anti-psychotics. As much as I hate the way they make me feel numb, I don’t know how I would survive without them. I fall asleep but my last thoughts as I drift away focus around the fear of dying. As hard as life can be, I desperately want to survive. At least for the moment anyway. 

How anxiety ruined my holiday

Holidays have always been an exciting and relaxing experience for me. My mental illness means that holidays have been especially important. I have no job, no children and a very limited social life. It sometimes seems like I have nothing to look forward to. I have nothing to talk about to people because nothing ever happens to me. I thought going away on holiday would fix this.

With this in mind, my partner and I saved money for ages for a holiday. There were a few doubts I had before I  went about how I was going to cope. Although I have had bipolar disorder for many years now, I had always managed to enjoy holidays in the past. However, it has only been relatively recently that I have suffered from a severe anxiety disorder. 

Having an anxiety disorder is in some (only some) ways more disabling for me than bipolar disorder. With bipolar my symptoms are better at some times than others. I can cope with going away on holiday when I feel better. However, severe anxiety seems to have stayed with me continuously for over a year now. I have had trouble breathing, panic attacks and a crushing feeling on my chest almost every day, sometimes all day. What I should have realised is that these symptoms weren’t just going to go away when I went on holiday. In fact, going on a holiday was likely to make them worse. 

I was really nervous about the flight because having panic attacks has meant that I have a fear of confined social spaces. If I have a panic attack, I need to be somewhere where people won’t see me. I need to be able to escape quickly so as not to embarrass myself. Cinemas, buses, supermarkets and other crowded places are all tricky locations for me. A plane is the worst possible place. People are packed on like sardines and there is no place to escape. I was so focused on this fear of the flight that I almost didn’t go. 

I didn’t have a panic attack on the plane. With the help of alcohol and some (very out of date!) diazepam, I managed the journey. However, I had been so focused on my fear of the flight that I hadn’t properly considered how I would cope with the rest of the holiday. We arrived in the city and I was instantly hit with crippling anxiety. 

We were picked up by the guesthouse at the airport. The first thing I had to deal with was the social anxiety. I had to try and make small talk with the lady that fetched us. She was nice enough but I am so unused to talking to strangers that I just couldn’t speak. I could feel the panic rising in me and was worried that she would notice. When we got to our accommodation we had to walk down this hectic alleyway with scooters flying past and I just felt terrified. I used to find this kind of experience exciting but I was just a nervous wreck. 

The roads were mayhem and I was too scared to cross them. The sights and sounds were so unfamiliar and I just felt completely lost. I basically hid in the hotel room for the next few days only popping out for food. When I did I couldn’t eat properly. I am a big fan of eating so this was quite disconcerting! I felt sick and kept feeling my body trembling. I couldn’t breathe. I thought I was going to pass out. I can’t describe properly how I felt because it was so awful that I seem to have partially blocked out the memory of it. All I remember really was how I felt like I was going to die. I just felt this absolute all-encompassing fear. It was how I would imagine feeling if I was hanging off a cliff edge with a rope that was about to break. It seemed like I had only seconds left to live except that the feeling lasted all day. It was relentless. 

It all came to a head after four days where I just broke down and sobbed on the bed. I knew then that I had to go home. Things weren’t going to get better. The unfamiliar surroundings were too much for me to cope with. We had to fork out a load of money to fly home early. 

I felt terrible. My partner was really upset and I knew that I had ruined the holiday for him. This was supposed to be his dream holiday and because of me he was not going to experience it. I feel so guilty. I can’t bring myself to tell my friends about what happened. I know I have to tell them some time because they will ask how my holiday went. I’m not looking forward to the awkward silence or the negative judgements. I know that many of them will say supportive things but I don’t know what they will actually be thinking. Perhaps I am silly to worry about what they will think but I can’t help it. What people think of me means everything to me. It shouldn’t but it does. 

My parents are there to care for me when my partner is at work. I get panicked if I am left on my own so I rely on them to support me. They decided to go away on holiday at the same time as us because they thought they weren’t needed. Now they know I am at home with only my partner to look after me. They are worried and I think they may not be enjoying their holiday anymore. I feel so ashamed that everyone feels like they have to revolve their life around caring for me. 

Holidays should be a time when people with mental health problems get to relax. We deserve some time to try and heal and rejuvenate. I try and tell myself this but it is hard taking my own advice. I thought that I was undeserving of a holiday and this latest incident has made this feeling even stronger. I can’t even appreciate a holiday. Loads of people would love to go away to somewhere but don’t have the money needed to go. I feel so guilty. Why can’t I enjoy things like everyone else?