Is life expectancy all that matters when we treat those with mental health problems?

Today I saw an article with the following title: ‘Mental illness can reduce life expectancy more than smoking’. You can find the article here: http://www.bbc.co.uk/news/uk-england-oxfordshire-27518408. It is based around research done by scientists in the Psychiatry Department at Oxford. Their research found that the life expectancy of someone with, say, bipolar was between 9 and 20 years less than average. People with other mental illnesses also had significantly lower life expectancies. I found these statistics quite shocking.

So what is the reason behind these lower life expectancies? The article cites suicide and risky behaviours associated with mental illness as contributing factors. Other possibilities mentioned in similar articles include physical illness overlooked by professionals, side effects from medication and an increased chance of developing cardiovascular problems and diabetes. All of these factors are worrying. 

I have had experience with one of these problems recently: I have found that I have not been taken seriously by doctors when complaining of physical symptoms. Any symptom I have had has been dismissed as being caused by anxiety or bipolar or a side effect of the medication I am on. I have even had bizarre symptoms being dismissed, like a mild finger deformity I have recently developed. It is easy to see how serious physical illness can be missed in a patient with mental illness. The reality is that people with mental health problems are just as likely as anyone else to suffer from physical illness, perhaps even more so. Doctors need to be more aware of this.

I think that many people will be surprised by how much lower life expectancies are for people with mental health problems. Perhaps it will cause some people to take mental health problems more seriously, which is a good thing. When people read about something tangible, like a reduced life expectancy, they may be moved to some sort of action to prevent this.

However, there is a danger of only taking mental health conditions seriously when they cause a reduced life expectancy. Early death isn’t the only way sufferers are affected by a mental health problem. Mental illness causes intense suffering whilst people are still alive! Every day millions of people around the world struggle with illnesses like bipolar, depression, anxiety, anorexia, OCD, borderline personality disorder and schizophrenia. Many of them will not die young or commit suicide but their suffering and disability is no less real. It is only less tangible to the public. There are no ways to properly measure this suffering but the sheer number of people with these conditions gives some indication of the extent of the problem.

Yes, we need to tackle the reduced life expectancy of those with mental illness. However, we need to be aware that people can also be severely disabled by mental health conditions. Their social life, potential for work and ability to lead a fulfilling life are all compromised. We must work on helping those with mental health problems because we care about their quality of life as well as their reduced life expectancy. We must help people because it is the humane thing to do. 

Review of Rachel Kelly's 'Black Rainbow'

Black rainbow is the heart-breaking story of a woman who seemed to have everything until she was hit by two severe depressive episodes. In her memoir, Rachel Kelly talks of her experience of depression and the mechanisms she used to cope through her illness. In particular she emphasises the healing words of poetry.

Rachel Kelly clearly and honestly describes what depression feels like. She talks of the extreme anxiety, the negative thoughts that whirl round the mind and the complete loss of will to do anything other than lie in bed. She rather beautifully describes depression as a black rainbow; all the colour becomes drained from your existence. I really felt for her when I read her account. I have had depressive episodes before but manage to block out the memories of them quite effectively. Reading the book reminded me of the struggle I have been through. 

Importantly, Rachel Kelly emphasises the sheer physicality of depression. Depression can make you feel like your body is falling apart. You can’t move, sleep or eat properly. You may have all sorts of aches and pains. Every small task such as showering, dressing and even going to the toilet is hugely challenging. Rachel Kelly describes this physical agony of depression perfectly. She correctly points out that the mind and the body are linked: that all human activity is psycho-physical. When you are depressed, the body suffers too. People who haven’t experienced depression should be interested to learn about the way the body suffers along with the mind.

Many people who have had depression will relate to the experiences she had with other people during her illness. She relied heavily on others during her depressive episodes, particularly on her husband and mother who were incredibly supportive. However, not everyone was as tolerant. The negative reaction that some people had to her depression was heartbreakingly familiar. Some people mistakenly believed that because she was usually a cheerful person she couldn’t possibly suffer with depression. Others didn’t believe that depression was a real illness and thought it was something she should just pull herself out of. Sufferers of depression will be all too familiar with these kinds of comments.

These negative reactions to depression feed in to the feelings of guilt and shame which many of those with mental illness suffer from. Rachel Kelly talks movingly about her own struggles with these kinds of feelings. At several places in the book she expresses her guilt at being depressed when she has such loving parents, husband and children. She feels like she should be able to control her depression. These are common kinds of thoughts among those who have suffered with mental illness. Of course depression can affect anyone. It doesn’t matter who you are, what you do and where you are from. 

Rachel Kelly describes in detail her journey through a bumpy recovery; every time she would get a little better from each depressive episode, she would then have another bad day. Nonetheless there were shafts of optimism and things gradually improved. She vividly describes the feelings of coming out of depression where the black clouds covering the rainbow gradually disperse. Suddenly colour comes back to your life and you start appreciating everything again. I really enjoyed her use of this metaphor and thought it provided a nice description of both illness and recovery.

Something that some readers won’t feel like they can relate to are her experiences with mental health professionals. Rachel Kelly received a lot of help from her psychiatrist and from therapists, which sounds like they were seen privately. Due to constraints on the NHS, many people will not have received such frequent intervention. This is not to dismiss the wonderful job that many mental health professionals do. It’s just that there isn’t enough funding to provide the kind of care required.  Like many others, I have been on long waiting lists to see people and don’t always get as much attention as I need.

Rachel Kelly’s main solace during her two severe depressive episodes was poetry. The book title ‘Black Rainbow: How words healed me – my journey through depression’ is a bit misleading as it may suggest that poetry cured her depression. In fact, in the book she doesn’t push poetry as a miracle cure. Rather poetry provides words you can cling on to when at your lowest point. She includes in the book many of the poems which provided her with much needed comfort. These may prove useful to many who can’t find the words to express their pain but feel like they relate to the words in the poems. Of course some people won’t find poetry comforting in their times of need.  Personally, I don’t usually find poetry particularly helpful. Like others, I may find solace in, say, music and art rather than poetry: something that Rachel Kelly herself acknowledges. 

She suggests a large number of other techniques you can use to try and protect yourself from getting ill again. For example, breathing exercises, good diet, supplements, physical activity and therapy.  All of these should hopefully prove useful to readers who wish to maintain good mental health. However, it is difficult to say which technique will work for which person. Rachel Kelly is careful not to outrightly reject any one method of treating mental health like, say, medication. She sensibly leaves the options open and gives advice on the many diverse ways you can try to control your illness. I would have perhaps liked to hear more about her journey through different medications.

There were so many things in Rachel Kelly’s book that I could relate to: the descriptions of what depression feels like, the guilt sufferers experience, the way you have to become selfish to survive, the weariness of battling the illness every day, the heavy reliance on family and the pressure to not appear ill in front of certain people. Rachel Kelly has produced a beautifully and eloquently written memoir full of honest and relatable experiences. This book will be helpful to both those who relate to her experiences and those who want to understand more about how depression feels. She offers plenty of advice on how to cope with such a devastating illness which both sufferers and carers will find useful. Rachel Kelly should be commended on sharing her very personal story. 

Scared of the psychiatrist

Today was the day that I always dread: the day of a psychiatrist appointment. I know I should feel really happy that I am getting seen by someone there to help me. I am lucky enough to have a really great psychiatrist that listens to what I say and takes me seriously. I am grateful, I really am. But, as usual, I am also full of worries about the appointment.

Will I be able to get across what has been happening to me? This is a big concern. I have a tendency to forget all the really bad stuff because it was so awful I have half erased it from my mind. I have to look back at my diary entries to work out how I was feeling and what episode I was having. Reading back through some of my behaviours is really distressing. I like to think that I am a good person, but sometimes I haven’t acted in the best way. I hurt the people closest to me when I am ill and that is not okay. They deserve better.

Even when I have read through my diary and identified the episodes, it is really hard to explain to a psychiatrist the sheer enormity and horror of what has happened. Each time I have a manic, depressed or anxious episode, I feel like another layer of my personality has been soldered off. The episodes are so painful, so sudden and so disconcerting that I feel like I lose a little of myself each time. I know that I used to be this enthusiastic but stable person with a strong sense of self. Now I just feel lost. I'm unsure of who I am, how I have changed and what I want from life. I can feel myself slide further and further away under the weight of the illness. The thought that I might lose myself completely is with me all the time.

Another worry I have is that I will come across too ill or not ill enough. I don't want them to get the wrong idea that I am completely fine because I am acting fine. I also don't want to tell them some of the more embarrassing stuff in case they think I am much more ill than I am. Yes it is hard to tell even a psychiatrist about why you feel the need to slice up your body, rock back and forth in the foetal position and make strange animal noises. I don't want to be hospitalised under any circumstances. 

My next worry is so petty and ridiculous that I feel silly even putting it down in writing. The thing Is that I really want my psychiatrist to like me. I want everybody to like me really. I always have done. I admit it. I am a people pleaser through and through. It’s lucky that I have some very strong opinions on matters moral and political. If I didn’t, I would probably abandon them all under the desire to please those around me. Shameful I know.

I want my psychiatrist to like me so that I feel affirmed as a person. I want them to like me so they will care about me and, in doing so, will be better placed in trying to treat me. Most of all, I want them to like me because I like them and have opened up to them. I don’t want to feel rejected. Of course, none of this should matter. They are expecting to see unwell people that need treatment and as professionals they should treat you the same whether or not they like you. 

But I can’t stop caring! What makes this all the more ridiculous is that in my bid to be liked I often come across as this really well adjusted, lively person. Obviously there are times when I am too ill to pretend, but I have to be pretty damn sick for that to happen. I always wear the mask. It’s automatic. I am not doing myself any favours by pretending but there you go.

On a related note, I feel panicked about seeing the psychiatrist in case I run out of stuff to say. I am not that talkative these days since I have been more anxious. I worry that it will take two minutes to say what I can think of and then there will be silence. I won’t know what to say or how to say it. I could divulge every single feeling I have had over the past few months but I tend to summarise it all in a paragraph. It is not really my place to keep the conversation going, but (like in all social situations) I fear the awkward silence.

My final worry, which is more of a reasonable one I think, is that there will come a point when there is nothing me they can do for me. I have tried so many medications now: a number of antidepressants, anticonvulsants and antipsychotics. They all have their side effects which are hard to stomach. There has been no miracle cure and I am not even sure if any of them have worked. I still have episodes of illness regularly. At least they get me to sleep which is obviously helpful. The only thing left for me to try now is lithium. If that doesn’t work there are no other medications. I don’t know what my psychiatrist would do then. They can’t exactly admit to you that they are out of options. But I have done my research. There is nothing else left. There is only so much they can do.

On a more positive note, the appointment went okay despite all my worries. My psychiatrist has put me on pregabalin for the panic disorder and wants to put me on lithium next time I see them. I will be seeing them in a month’s time to discuss going on lithium. Now I have a new thing to worry about for next time: should I go on lithium? Should I risk the side effects, have to deal with all the blood tests and worry about the effect it might have on a baby if I become pregnant?