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?

Yes you can be mentally ill, on benefits and go on holiday!

I think that there is a huge problem with how the mainstream media portray people with mental illness, people on benefits and people that fall in to both categories.

On this topic, the BBC have just published an article with the following headline: ‘Agoraphobic benefits cheat Tracy Johnson jailed for year’. Apparently Tracy Johnson claimed to have a number of mental health conditions. These included anxiety, depression, PTSD, hallucinations and agoraphobia. However, she was found to be working as a tour guide in South America. She was charged with falsely claiming £48000 in benefits. It was argued that she could not possibly be agoraphobic, or suffering from the conditions she said she suffered from, if she was able to travel the world. You can read the article at the following link: http://www.bbc.co.uk/news/uk-wales-27130728

There are a few things I want to say about this case and the way it has been reported. At the outset I want to make clear that I do not know if the correct verdict was reached; I do not know all the details of the case. Ms Johnson very well may have been fraudulently claiming benefits. However, there are a few problems I have with the coverage of this case and the way the article, the judge and the prosecutor have portrayed people more generally with mental illness who depend on benefits.

First of all, the article refers to Tracy Johnson living a “champagne lifestyle” because she has managed to travel to some holiday locations. There are two problems I have with this. First of all it implies that people are able to sustain elaborate lifestyles on benefits alone. This idea is misguided. The benefits system really isn’t as generous as many seem to think. It is hard enough to qualify for any incapacity benefits in the first place. The way that the Work Capability Assessments are set up makes it very hard for people with mental health problems to be found as unfit for work. If you do qualify the money isn’t enough to live a life of luxury on. It is enough money that the government believes you can just about survive on. 

The second related problem I have with this use of the term “champagne lifestyle” is the idea that anyone who is able to travel must be incredibly wealthy. Of course this is not the case. People choose how to spend their money depending on their priorities and for many a holiday is an important part of life. A benefit claimant may choose to use money from their benefits to travel to take a break and recuperate. This does not suddenly make them wealthy or extravagant.

The prosecution implied that if you have a mental health problem and you are on benefits, you should not be able to travel. As Ms Johnson herself says: ‘I am entitled to a little break. I think I'm entitled to go and sit on a beach in Goa.’ Of course she is. As long as she is not fraudulently claiming benefits obviously. People are entitled to spend their money (earned or through benefits) on what they see fit. Again, as she herself says: ‘you can sit on a beach in Goa watching the sunset and still be in a pretty desperate state’. Just the fact of going on a holiday when you have a mental illness does not mean that you are fraudulently claiming those benefits. Mental health conditions affect different people in different ways.

At one point the article states that ‘Johnson, who has also written novels, had posted on Facebook: "I am one spoilt girl”’. I am not sure what the relevance of the fact that Ms Johnson has written novels is. The subtle message seems to be something like this: of course Ms Johnson could not suffer from mental health conditions. She writes! People who are mentally ill are obviously incapable of writing or of any activity for that matter. We just sit around in a daze staring at walls all day. Better to lock us all up and make sure we never take a foot outdoors. No writing or travelling for us. 

The prosecutor sums up his case by saying that: “Tracy Johnson was living the life that honest, decent, hard working taxpayers could only dream of. While workers were going out to do their daily grind, she was shopping in New York or having a few days in Madrid.” Those on benefits have heard this kind of rhetoric before. The ‘hard working taxpayer’ is once again held up as the paradigm of virtue compared to the scrounging person on benefits. The indication being that those on benefits should be bloody grateful for what they get. If they are not fraudsters they are still an ‘other’ to the decent taxpayer. They don’t deserve holidays or respect for that matter. The language and the message are divisive and cruel.

People with mental health problems often find themselves incapable of working. They are forced to rely on other people for help. However, that help doesn’t come for free. There is a huge stigma surrounding those on benefits and the government and the media often portray them as scroungers, burdens on the taxpayer and fraudulent liars. Regardless of whether or not Ms Johnson was fraudulently claiming benefits, the implication of many articles in the media is that this kind of fraudulence is widespread. However, the real estimated level of benefits fraud is said to be less than 1%. 

To have to deal with this kind of stigma on top of your mental health condition is exhausting and painful. Those with disabilities on benefits are people who deserve to be treated with kindness and respect, not distrust and derision.

Do my symptoms mean I am going to die?

I have had a really tough time this week. It all started on Wednesday. I was going to bed and I noticed that  my right hand was in a strange claw like position. My ring finger and my little finger were all curled up which was weird. When I woke up the next day I noticed that both hands were slightly claw-like and my little and ring fingers were numb and weak. I had all these strange pins and needles sensations in my arms as well.

The trouble is that when you are feeling anxious already, any slight thing can trigger a major panic response. I thought: SHIT I am going to DIE. I thought it could be some strange neurological condition where I would eventually die a horrific painful death. 

Anyway, of course I spent hours on the internet researching what I was about to die from. Obviously all sorts of things came up. The one thing that fitted the most was cubital tunnel syndrome which is when the ulnar nerve in the arm gets trapped, often from spending too much time with your arms bent or leaning on your elbows (Oops, my obsessive use of the laptop may be to blame). I was slightly relieved at first that it was a minor condition. However I then identified all sorts of things that can be a risk factor for cubital tunnel syndrome: diabetes, hypothyroidism, multiple sclerosis and many more.

I soon started getting all sorts of other symptoms. My legs were going numb and I got pins and needles in them. I started getting dizzy and breathless. Suddenly I would feel this sensation in my neck like someone was throttling me and I would gasp for air. I thought that these were all signs of something much more serious. Because I thought I was dying, I had a full blown panic attack.

Since then I have remained in a constant state of anxiety. Anxiety doesn’t quite describe it. More like a constant state of PANIC. I keep hyperventilating and feeling like I am blacking out slightly for a second at a time.  I am convinced I am going to die even though as I write this I realise how irrational I am going to sound. 

There are so many physical problems that arise due to anxiety. I am absolutely sure that there was an original problem with my fingers but ever since I panicked over the whole thing, I don’t know which symptoms are ones to be worried about and which ones are down to anxiety. 

I am seeing a doctor on Thursday but it is not my usual doctor. I am scared that, like so many other doctors, they will put all of my symptoms down to anxiety and bipolar. When they see it on your medical records they jump to conclusions. No wonder so many people with bipolar seem to die young. Often symptoms of serious illness are missed because they are put down to the illness or the medication.

I wish I could tell which symptoms were caused by real physical problems rather than symptoms caused by anxiety. But I can’t. I just feel so pathetic and useless getting so worked up over something that is probably so minor. I feel an intense hatred towards myself. How ridiculous. People around the world are suffering from all sorts of serious illnesses and here I am worrying about weak, clawed fingers. 

It is almost like I had this anxiety building up inside of me already and it just took this slight trigger, the numbness in my fingers, to set me off in to panic mode. Sometimes I feel like I have anxiety just floating around in my brain and then something small happens and all my anxiety gets focused on that one thing. Sometimes it is social situations, sometimes things like flying in a plane, sometimes physical illness. 

Just writing this down makes me feel better and worse at the same time. I feel better as I realise how stupid I am being and I feel worse because I realise how stupid I am being! Right now I am just struggling to get through each anxiety ridden minute. I feel desperate. Diazepam is the only thing that helps but I can’t just live in a drug induced coma for weeks on end. I am so tired and just want to sleep where I can escape the anxiety for several glorious hours. 

It is ironic that just a few months ago I was experiencing suicidal ideation and yet now I am panicking about dying. I have often fantasised about the relief of mental pain through death. Now all I can think about is how I desperately want to live. Not like THIS though.

Honesty or positivity?

I was looking through my blog posts today and thinking lots of negative things. Of course, there were the standard problems of mistaken spellings and bad grammar. What really bothered me though was the inaccurate way I may be coming across.

I try to be completely honest in my posts and open up about things I would never talk about in real life. I would never tell anyone who knew me IRL that I self-harm. I wouldn’t tell them about scary intrusive thoughts I have or any of my catatonic behaviours. These are all just too embarrassing for me and hard to admit to, even to myself.

I realised though that the way I was writing a few of my posts was not completely honest. I noticed that I was often ending my posts on some sort of concluding positive note. I guess I thought that people would be annoyed with a negative or abrupt ending. It’s like when you read a book and you feel really let down if there is not some kind of upbeat or fulfilling conclusion. Sometimes the whole time you spent reading the book seems like a waste of time if there is not a satisfying end.

I seem to have applied this to my blog writing. But real life is not like this. There is no settled ending to what I am experiencing with my mental illness. The story just keeps unfolding. Sometimes there is a positive outcome or message; maybe I have grown as a person or become more hardened to life. However, often there is no positive spin I can take on my experiences. Sometimes what happens is just a bit shit really, but I’m forced to keep going in the hope that things will get better. Sometimes they do and sometimes they don’t. 

You are stuck between a rock and a hard place when trying to blog, tweet or talk about your mental health condition. Some people will always be going through a tough time and will talk about their battles every day. This could be seen as honest and refreshing but some would view this as negative and draining. Alternatively some people will try and be really uplifting in an attempt to bring everyone up with them. This is a noble intention but some people will view it as dishonest about the daily struggle of living with mental illness

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Personally, I admire all people who talk about mental illness, whatever their take on it. However, I still can’t help but feel like a fraud when I try and send positive messages to others with mental illness. When I see someone struggle I just want to hug them and say something encouraging. I could say something like ‘I am sure you will feel better soon’. However, I know that things sometimes don’t improve; sometimes a mental illness is chronic. 

So do I help people with positive messages and feel like a fraud? Or do I go down the honest route and drag people down with me? 

Personally, I think that I should be honest about how harrowing the experience of mental illness can be. You can’t help people with positive messages if those messages are empty. Just talking honestly about your MH experiences can be helpful to some people. If they recognise the similarity of your experiences to their own, they feel less isolated and alone.

Importantly, I think that there are ways you can be honest in a positive way when you are trying to help someone. I don’t think that just being honest about your experience drags people down. However, being honest about your difficult experiences without listening to others may not be that useful. To help people, you need to not only tell your story but allow them to tell theirs. 

When they feel down, listen to them. You can offer positive advice, as long as it is truly meaningful. Just saying ‘things will be better tomorrow’ or ‘there is always a silver lining’ are not very helpful because you can’t possibly know these things. 

So what should you say? You can say that you hope they will feel better soon and that you are thinking of them. If appropriate, you can remind them of times they have not felt like this and point out that they may feel like this once again. Perhaps you can point out that some people have managed recovery or remission and so there may be hope for the future. Most importantly, you can just show that you and are there for them and they are not alone.

I think that honesty about mental illness is crucial in getting more awareness out there and in helping people feel less alone. However, positivity also has its place. As long as those positive messages are truly meaningful.

Mother's Day and World Bipolar Day

So everyone knows that it is Mother’s Day today. Apparently it’s also World Bipolar Day (who knew?). I thought that this would be a great time to write about my Mum and how she has helped me during times of my bipolar flare ups.Not everyone is lucky enough to have a supportive parent so I am really grateful.

My Mum has always been the strong one in my family. She holds everyone together. The rest of us always joke that her catchphrase is: ‘I just want everyone to be happy’. Her happiness seems to be completely tied up with how everyone else is in the family. It is very noble of her but also it worries me that she doesn’t look after herself enough.

It’s a shame that so many mothers put such little emphasis on themselves. Society expects them to be constantly selfless and maternal. Mother’s aren’t expected to be individuals with their own personalities, desires and needs. Of course they are just human like the rest of us. They deserve to be treated with respect every day of the year, not just Mother’s Day.

My Mum is a really interesting person. She is shy and introverted but at the same time full of personality. She is very logical and analytical and one of the most intelligent people I know. However, at the same time she manages to be completely daft and silly. She is one of a kind and deserves to be recognised for more than just her role as a carer.

Unfortunately my Mum has often ended up taking the carer role. She has always been there for me during times of crisis. When I was first having mental health problems as a teenager, I was fighting a lot with people in my family. I was irritable and depressed and taking it out on everyone. Within the family, it was my Mum who tried to keep the peace. She was the first to recognise that I was ill and not just being difficult. She was the one who pushed me to get help.

Over the last thirteen years of having mental health problems my Mum has been my main source of comfort. I am very thankful for the other people in my life who have also supported me but it is my Mum who manages to be the most patient.

When I am depressed she doesn’t get irritated but encourages to get up, get ready and exercise. She forces me on walks and makes me leave the house, even if it is just for a coffee. The rest of my family often get frustrated and down over my lethargy and low mood. This makes me feel really guilty. However my Mum almost always remains cheerful which helps bring my mood up, if only a little bit.

When I am manic, my partner and my Dad find it really difficult to deal with. I can completely understand why. I wouldn’t cope very well with someone running around the house, screaming and laughing and trying to play fight with me. It can be funny sometimes but often I am the only one laughing. Everyone around me is a bit creeped out! My Dad’s response is to get angry when gets matched with explosive rage on my part. My partner’s reaction is to get really sad and upset which doesn’t help. These are both natural reactions and so I don’t judge them for it. My Mum’s reaction is the most beneficial to me though. She tries to keep relaxed and just goes with the flow.

Mixed episodes are the hardest for everyone to deal with: the endless pacing around, the wailing, the psychomotor agitation, the screaming in terror, the paranoia, the desire to inflict violence on myself. I shudder to remember these things. My Mum sits with me as I pace around, just to make sure I am safe. She doesn’t try and stop my from moving or try and reason with me. She knows that these won’t help.

What my Mum does for me is amazing. She watches my moods closely, spends hours talking to me, often daily, and she organises my life to try and keep me in a routine. What is even more amazing is that she manages to keep on being her lovely self. She doesn’t let the bipolar drag her down, although it obviously affects her deeply.

I try to remember that she is not just my Mum and my carer. She is my friend and a really interesting person. I am grateful to have her in my life.

What's in a face?

I used to think I could tell a lot about someone from their face. But I was wrong.

Obviously someone’s basic physical appearance doesn’t tell you anything about that person. However, I used to think you could read a lot about someone’s personality, thoughts and feelings through other physical cues which show up on their face and body. 

For example, body posture could indicate a number of things. If someone is strutting around you may infer that they are confident or, perhaps less kindly, arrogant. If someone is walking around in a less purposeful manner, stooping their shoulders and darting their eyes around, this could indicate that they are anxious and insecure.

The face is often thought to expose even more about a person’s personality. Perhaps if someone is smiling all the time you think of them as happy go lucky. If someone always furrows their brow you may think that they have a nervous or contemplative personality. 

The face may also expose someone’s thoughts and feelings at any one time. You look to the face to see how someone is responding to what you are saying. How they tense their mouth, move their eyebrows, where they fix their gaze and whether or not they laugh may all indicate what that person is thinking and feeling.

What I have realised over the years is that just as people lie in what they say, they are capable of performing non-verbal deceptions too. And I now strongly believe that these non-verbal deceptions are not the exception to the rule. People hide how they feel ALL THE TIME. The person who struts around is often just trying to hide their true feelings of insecurity. The person that always smiles may be covering up a deeper, darker personality. The person who never looks irritated at the controversial things you are saying may be seething underneath. 

The face that people show to the outside world may mask all sorts of thoughts and feelings. We constantly modify our facial expressions in to those that we deem socially acceptable. We want to make sure our face is responding in the ‘right’ way so that we are communicating what we want to be communicated about us.

This brings me to the topic of mental illness. Because of the stigma surrounding mental illness, those with mental illness may have a vested interest on hiding any negative or ‘strange’ thoughts and feelings. I often believe that it in my best interest to keep my condition hidden from others. This is why I blog anonymously. It is also why I modify my facial expressions to mask my inner turmoil. 

I want people to see me as a functioning, social person, capable of taking care of myself and others. I want them to see that I am engaged with what they are saying to me (even though I am often drifting off in to my own distressing thoughts). I want them to see someone who is capable of having fun and laughing along with everyone else. 

I often think that I must be giving off all sorts of signs in my facial expressions which indicate that I am feeling mentally distressed. The feelings which I have are so intense that I wonder how it is possible for other people not to notice. But they don’t. Not most of the time anyway. I must be some sort of facial disguising expert!

How much can you really tell about a person through their face? I would say: not as much as we would like to think. People lie about how they feel all the time and this extends to their facial expressions. 

Should we be pleased that we can hide our true feelings from our face? Yes and no. Obviously it would lead to quite a lot of social discord to always have people be able to read our thoughts and feelings from our face. We think lots of fleeting negative thoughts about others which may be best kept hidden. However, if you always hide your true feelings from your face, you can end up feeling very alone.

Many people with mental illness are having to perform a daily facial disguise operation. Society doesn’t exactly make it easy to feel okay with showing your distress to others. The pressure to conform is huge but the isolating feelings which come with conforming can be hard to bear too. I really hope that as time goes on it becomes easier to talk about mental illness. Then we can finally let our faces just relax for a little bit!

Bipolar versus anxiety

I have both bipolar disorder and a general anxiety disorder. Most people think that the bipolar disorder is the more serious mental illness and in some ways this is true.

When my mood is manic or mixed I can become very paranoid, hyperactive, restless and distressed. I exhibit more typically abnormal ‘crazy’ behaviour like running around in circles, speaking incoherently and screaming. This makes socialising, work and normal day to day activities impossible.

The thing about mania though is it only happens in episodes. It may last for a few months but thankfully it ends. It is the same with depression. The episodes are horrific and completely take the life out of me. However, because they are acute in some way I can cope with them. I know they will end eventually.

Anxiety is a different story. It is there with me all the time. I am anxious about any kind of socialising, being seen in public and random other stuff like being stabbed when I am walking around outside. I can’t function when I am manic or depressed but anxiety cripples me every day.

The problem I have been having over the past couple of months is that the anxiety has reached a level where it is just as invasive as the bipolar episodes. I feel a sense of dread all the time. I get waves of nausea. I find it hard to breathe and my chest feels really tight. I am dizzy and I feel tired all the time. I keep getting panicked that I have some kind of physical illness but these symptoms are all consistent with anxiety.

But I feel like I am DYING. Like at any moment I could drop dead from lack of air. I am trying so hard to remain calm but I can’t. Everything in my body feels wrong. I keep over thinking things and noticing weird stuff. Like how big my tongue feels in my mouth. And how weird it is when I shut my eyes and I can see the darkness. And how often I swallow during the day. All of these normal things suddenly seem completely abnormal. I try and fall asleep at night but just as I drift off, I feel a sudden jolting pain in my chest and wake up in a panic. I am now afraid to go to bed. I make my partner stay up next to me and wait for me to fall to sleep just in case.

I wonder if I might stop breathing at any moment. I don’t want to die. Death terrifies me. But I don’t want to live like this either. The strange thing is that I don’t have anything to feel anxious about. I am worried about being off ill from my PhD and losing my funding but I am not thinking about it constantly and it doesn’t seem to coincide with the anxiety attacks. In fact the thing I am most anxious about is feeling anxious. It’s a vicious circle.

The only thing that keeps me going is writing and the internet. They are so engaging that I am briefly distracted from the anxiety. However it all comes rushing back as soon as I stop. Perhaps I should just be online all day!

People don’t take anxiety disorders seriously enough. They sit up notice when you say that you have bipolar disorder. Of course with this comes all sorts of judgements about how scary and dangerous you are. However, with anxiety it is like people don’t see you as having a real problem at all. Because everyone gets some feelings of anxiety occasionally they think they know what having an anxiety disorder is all about. But they don’t. They haven’t had to deal with it day in and day out and at such an extreme level.

Depression, mania and anxiety have all taken their toll and it is near impossible to say which is the worst. i tend to think whatever mood state I am currently experiencing is the most difficult one.

I am tired. So tired of being this wound up. My body can only take so much. I don’t know when the anxiety will subside but it feels like it will go on forever. I am mentally and physically exhausted.

Am i feeling manic or depressed?

When you have bipolar disorder it can be really hard to identify the mood you are in.  When I experience a depressive episode it's often quite easy to identify it as such. My whole body shuts down and I feel like I can’t do anything. The feelings of despair are overwhelming and the negative voices just won’t leave me alone. I know that I'm depressed but I can't do anything about it.

However, when I'm not depressed it can be really difficult for me to tell what mood I am in. The problem is identifying the difference between just feeling ‘normal’ again and experiencing a swing towards a manic episode. Throw in the possibility of a mixed episode, where you experience mania and depression at the same time, and things get really complicated. 

I went through a stage of obsessive blogging just recently. In hindsight I think it was because I was on the manic side. Only I didn’t recognise it as such because the frenetic drive was tainted by a low mood. In other words I was having a mixed episode.

I thought that my drive was just because I was back to feeling more normal again. I thought now that the fog of despair was lifting, I was back to feeling inspired again. I had all these ideas for blogging and for my creative writing. I finally felt like I had a purpose. The lack of working or studying meant that I had been feeling particularly worthless and this was giving me some sort of self-esteem boost.

My inspiration of the past two months collapsed about a week ago. I suddenly felt drained and all written out. I look back at what I wrote and I see all the mistakes. I realised that my sudden feelings of being inspired were misplaced. It was just mood related and didn’t lead to anything amazing. No one cared anyway! I was caught up in the whirlwind of manic excitement and now it has all collapsed around me.

I don’t even know what mood I'm in now. I feel pathetic and hopeless. I have to email my university department today to tell them I'm not coming back for another term at least. This may mean they cut my funding and so I'll never be able to complete my PhD. Part of me would feel relieved in the sense that I wouldn’t have to go through the stress. However, a much bigger part of me would feel like a real failure and like I've completely wasted the last few years. 

Sounds like I am depressed from that description. However I still feel WIRED. I feel like my brain is buzzing away at me incoherently and like I can’t turn the switch off. I'm ignoring everyone around me because I don’t know what to say or how to describe my mood. I ' just attached to my computer in the hopeless task of distracting my brain from itself. It's doing something nasty and I don’t like it one bit. 

Usually my posts have some kind of point or message but I'm not sure this one does. I guess I mainly wanted to say that I feel all over the place. I'm not manic but I am not exactly depressed either. I guess I'm distressed and confused by this mood state. I just hope it doesn’t last too long.