R-E-S-P-E-C-T Let's Talk About Mental Health - Comfortably

I cannot believe it has only been five days since I wrote my manic Monday post. I am feeling distinctly odd after three consecutive nights of very little sleep at all, trouble even with getting to sleep, as well as my old favourite - trouble staying asleep - which is my biggest problem.

I expect attending the judging panel for @womenoffuture (Women of the Future awards) this morning did not induce additional drowsiness! I was so excited to have the opportunity to talk about mental health and the need to end the stigma around this widely experienced and more widely misunderstood category of illnesses. I also felt tremendously grateful to be in a position to speak about it: mental health for me is one of our most critical health issues in this country and globally.

It continues to become more and more apparent that mental illness does not discriminate. Speaking today to the judges I remarked upon this. There is not one group of people I can think of - whether we think about gender, age, ethnicity, sexual orientation, nationality, lifestyle, or life, in fact - where mental illness is not present. We may have 1 in 4 people with a mental illness in the UK, but that means that so very many more people are affected by their connections to those 1 in 4. Let's think of the mothers and fathers, the wives and husbands, the children, friends, work colleagues, medical professionals and strangers who are interacting every day with those 1 in 4. We are living in a world of tremendous pressure and challenge. I would be very surprised if many people at all were completely free of connection to someone with a mental illness (themselves or others).

The paradox is that while mental illness is everywhere, silence about it is also everywhere more often than not. We still do not talk about mental health comfortably. I try to, with my known background in this area serving as an "easy chair" to slide into for this discussion, but others who are speaking of their illnesses or struggles for the first time cannot gauge the reaction of others as there are so few precedents; cannot guarantee that when they take that huge step, that leap, risking so much, while so ill, to be honest about a part of them that is unwell and needs support, that they will get that support. They might not even receive acknowledgement, let alone respect and help.

The judges asked me what I would do if I won - what I thought needed to happen - to improve things. For me, it isn't about providing support mechanisms in the work place or better NHS care (although both of these things are absolutely critical and the latter is in dire need of help, with so many people excluded from care as they do not qualify for treatment based on basic statistics. For example, did you know that if you had an eating disorder and presented with a BMI of 17.1 (i.e. .9 points below the lowest 'healthy' weight for a height of about 5'5") that you would be turned away from A&E (the ER) and asked to return when your BMI had dropped further. You would not be deemed sick enough to receive care. "Please lose more weight." = "Please get sicker, and then maybe we can help you.") 

This is what I said needed to happen, and what my focus for the next three years will be: "We need to make it normal for people to talk about their mental health." 

Why did I say this? 

Imagine if you had a very unpleasant spot on your face. You can use concealer to hide it, sure, but at the end of the day, you're very aware of a throbbing, red, sore, mass on your face that you know you'd far rather would disappear, and you're pretty sure everyone has noticed. But if you tell people about it, you're more likely to get empathy and shared stories (and recommendations of nuclear strength Clearasil), as well as perhaps the odd puerile cry of "That's gross" than have people fall silent, look down, say "Oh," and nothing more. Say nothing. Walk away.

Imagine if you could walk into the office, and on the second (or third) round of 'How are you?'s (because we know that the first is a saying hello, and the second might be a reflex action from the first) that you could say, "I'm feeling quite anxious today, so I didn't sleep that well" or "I'm feeling quite unwell mentally. I think I need to take it a bit easy today to try to prevent things getting worse." The latter statement makes perfect sense to me: you're not feeling well, and you've got to work / go to school / attend your child's school play / go and run errands. Therefore you see how you can reduce your 'to-do' list for the day so that hopefully those sniffles or early symptoms don't turn into flu (or, worse, man flu. Hor.ror.). And so your sick feeling isn't exacerbated by excessive travel. 

Why is it, then, that we so rarely hear people say anything about their mental health? Why is 'presenteeism' (which is where people show up to work with a mental illness (or any other kind of illness) but pretend that they're fine when really they are not and probably shouldn't be at work) so prevalent in our world? Why do you so rarely hear people say that they are off sick "because of depression", rather than because of a cold, flu (man flu!), food poisoning, tonsilitis, etc? 

I think the answer is, because hardly anyone says that. Still.

People don't say "I'm feeling depressed today" / "I'm feeling manic today and can't concentrate" / "I need to sleep today because my anxiety kept me up all night". People don't say it, so people aren't used to hearing it spoken of. And so people assume they can't say it themselves. They assume it's not an acceptable statement to make, and not a "good enough" reason to be absent from work.

We do - desperately- need to help people get the support that they need, but if they can't talk about it in the first place the likely outcome is that they won't seek help. They won't feel it's important/ a valid illness. And before that, they will not feel they can even mention it. 

We know that men struggle more than women to even voice struggles with stress, anxiety, depression and so on. And not talking about this can be - literally - deadly. The number one cause of death among men aged 20-34 is suicide. And this could so often have been prevented by better comfort levels for saying: "I feel very anxious." "I need help." "I am not okay." 

Gender / other factors aside, the bottom line is that people really feel they cannot talk about their struggles with mental health (even with stress). They feel ashamed, weak, less than. Like they mean nothing. 

This is so wrong. We all matter and we all deserve respect, courtesy, kindness and care - for ourselves and others. If we could change this situation and make talking about our mental health as easy as discussing a nasty spot or, say, a broken arm, shingles, or flu, this would mean that our serious and debilitating illnesses would not be worsened by the massive shame we would associate with having them. I personally have berated myself, hated myself, shamed myself and been disgusted with myself for being ill with depression. Why? Why is my illness so shameful? 

It isn't.

If I had not been so ashamed I firmly believe I would never have become so ill. I know that because being honest with my team is the same as making me feel instantly lighter. I haven't had to pretend I'm fine when I'm not, which in the past twenty years at school, university, in my jobs to date, I have done, and which has made me feel more ill: not just sick, but sickened by myself, by my sickness.

So that is where I would start. With more conversations until mental health conversations are "normal". Until people feel they can say, "Today I'm depressed." "Today I'm anxious." "I need help please." "I need to take a day or two off." And I can't wait to get that conversation going again any chance I get, and definitely at the Women of the Future summit in October. In the meantime, let's talk about mental illness and mental health. We all have mental health. Let's make it easier to make time to talk about it. Please help by starting your own conversations.

Just Another Manic Monday: Lists of Then and Now to Fight My Anxiety and Depression

At the weekend I planned to write a piece on authenticity. As a business woman I am exploring what this means. We all have our work personas, and our others. One of the most interesting things I've read is that we can change - we won't stay the same and shouldn't expect other people to either. It's part of our evolution. That's why we do performance development and change management. Because we need to change. However, one thing that isn't going to change is my list making...(see below!)

I don't believe we have to show everything to be 'authentic', but at the same time, being able to be honest about the part of me that has depression and anxiety.

Today I'm feeling really unwell, so this is what I can do. I'm hoping to write more on authenticity - especially in business. For now, here is a blog about how I've made changes to try and combat Monday morning anxiety.

Five years ago, if you asked me what Sunday night looked like, I'd say this:

Just to avoid misinterpretation, no, dear reader, I am not George Clooney.

1. I would pack my suitcase for the week ahead, make a note of all the things I needed to remember to do (that I hadn't remembered to make a note of on Friday)
2. I'd look forward to a cold, crisp glass of sherry and a delicious Sunday dinner.
3. I knew I probably wouldn't sleep well because I'd be thinking of all the activities ahead of me (which despite taking careful note of, were whirring around my little head like a carousel whirring and blurring at 100 MPH).
4. I'd be aware of the earlier-than-normal time I needed to wake up to ensure I got the train to wherever work was taking me, and this would mean my sleep would be broken - I'd wake up half a dozen times to watch the clock, even though I would have set an alarm.
5. I might have dreams about work - often - and I might think of new things to add to that to do list. All in all, I'd have a fairly rough start to the week, which I'd treat with a bottle of diet coke (or two), a fair breakfast bought at the station and a blurry Monday trying to get through various meetings whilst not falling asleep or seeming manic because of the amount of caffeine I'd consumed to make Monday working even a possibility.

Overcaffeinated? Yep.

What has changed? It's Monday morning.  I woke up feeling horrific, but now I know that I can employ various things to try to ease this and help me get through the day.

I feel terribly anxious after a nightmare-filled broken night of sleep where I dreamed of a wider to-do list including both life things (like trying to sell the house, tidy the flat, clean, and a long list of work activities). This means that I'm feeling physically sick, with bile present in my chest and rising in my throat.

There is nothing I can do about that, or my bad dreams if I've practised healthy behaviours before bed. Here are my best behaviours. I try to do these every day.

1. I go to bed in time to be awake for a decent amount of time getting comfortable in bed and 'finishing' the day in my head. 
2. I drink water with my tablets and only drink water (and plenty of it) after bed and beforehand. I don't drink any caffeine at all but I used to not drink any after 2pm
3. I read something that is not too challenging and not upsetting before bed on my Kindle, on the lowest possible light setting that I can manage during the dark. I find that looking at my ipad or iphone before bed can disturb my brain with the backlighting and make it harder for me to get to sleep.
4. I put on a programme to listen to before sleep which my brain will focus on (meaning not on the 1000 alternatives possible) and this concentration relaxes my brain and usually is the magic silver bullet to make me go the f*** to sleep.

You can buy this excellent book here.

Having done these last night, I'm feeling just as tired as I would have been five years ago, and have a list in front of me that I'm crossing things off from. A list is helpful to me for these reasons:

1. It helps me to realise that it's unlikely I've forgotten something, and stops my mind from racing around trying to repeat the things I have to do the next day / in general again and again. 
2. When I cross things off (even if it's just writing an email) I feel like I'm making progress and it makes me feel more in control. (And yes, I am one of those people who even puts things already achieved onto that list...it's good to remember that you've achieved something already!)
3. I can build on it throughout the week and decide to allocate some of the items to other later days depending on how my health is.

On the other hand, I didn't have anything to drink on Sunday night (or at any time on Sunday in fact); I didn't have a suitcase to pack because currently I don't have to work on client work away from home, because of the project types I'm working on. I didn't eat a Sunday roast.

I went to bed at around 6-7pm because I wasn't feeling at all well. I also now have a host of drugs to try to help my depression and anxiety and the medication that I take to allow me to take that medication, that is, to help with side effects of insomnia, restless leg syndrome and, yes, anxiety.

What else do I do to make myself feel better? There are quite a few things that I know can work (even though they don't always). Here is a view of what I do to try to combat anxiety and depression and allow myself to work and get through the week ahead. Let's start with work things:

1. I decide to work from home (or I give myself the option to do this). I know this is not possible for everyone, and I feel that my current employer KPMG is absolutely essential to allowing me to do look after myself when I'm feeling really unwell. For some of the #selfcare activities I'll need to do, working from home for me is - today and on many other days - the difference between being able to work and having to take the day off sick. I'd much rather work if possible, especially because I enjoy my work and work is a welcome distraction from feelings of depression and the ruminating / worrying voices in my head, so, for me, this is the best possible outcome.
2. I make the list (hahaha, now you know I make lists!) (see above) both for work and for my non-work activities. It's really important to me that I set up my teams for success and that I set myself up for success (in spite of mental illness) by making a plan which I can put in place to support everyone I work with through the week, and enable me to be useful, work effectively, and not hold people or projects back (which would make me feel worse).
3. I am open with my colleagues about how I'm feeling. Today, for example, I can't take phone call after phone call as the constant contact might increase my anxiety levels, so I've made some calls and rescheduled others for tomorrow, ensuring we still make progress but not to the detriment of my health.
4. I arrange some critical meetings face to face for tomorrow, so that I can prepare for useful meetings on one day, in a reasonable (2/3 day) space of time to give me breaks to sit alone, quietly and have food and water between these. I need breaks to enable me to keep going.
5. I use technology (which is my business anyway!) to help myself to stay connected with colleagues and support them: Skype for Business (which allows desktop sharing and collaboration on group calls between India, USA...the world). I can review many of my fab team's work products through our online document storage options and lots more. It's good for my mental health if I can stay in touch with everyone - stay connected - and feel a part of my team even if I'm not well enough to go into the office.

And on the non-work front, here are the things that I have done (and do) to try to help myself feel as well as I can:

1. I get up and go for a run. My energy levels are better in the morning and if I manage to complete a run then, that's the best chance I'll be able to do exercise because after a day of work I'll be shattered.
2. I don't drink caffeine of any kind except very, very rarely (I've had 6 diet cokes this year). Caffeine can have an impact on my medication and make me high / then low after the post-caffeine crash. It's a mood altering drug so I'm avoiding it to try to give my medication the best change of working. This might mean I am more tired than normal in the day, so if I am shattered, I build in breaks (as above). 
3. I make myself (or buy) juice from breakfast (beetroot, carrot, apple and ginger). More from the Mayo clinic on anti-anxiety nutrition guidelines here. 
4. I drink plenty of water all the time. It's great that I don't like coffee, tea etc. but I do miss diet coke. I love the no added sugar fizzy drinks from Marks and Spencer and I certainly am not a perfect diet person - it's just some things I can do, but I'm not a paragon of nutritional virtue - far from it.
5. I eat nutritious food, but also nice food. Crisps are a non-negotiable. I also can't give up bread. I. Love. Bread. And I will eat cookies too. Refined sugar might not be the best thing, but it tastes nice.

It's only 12.03 and I've got a lot more hours to get through. So here goes. But I hope for anyone reading this and wondering how they're going to get through the next few hours. Me too.

You Make Me Sick: My Week of Anxiety

This week has been distorted with a weird whirl of media because of public appearances (even though they were staged, pre-recorded, pre-written etc. weeks ahead of broadcasting / publication). Media distorts things, whereas the reality is very different. Tuesday and Wednesday were bizarre, as I was tagged on Facebook appearing on the BBC without knowing anything was going to be broadcast that day, and being published in Metro.co.uk writing a light-hearted piece about anxiety.

Metro piece - a lighter look at Anxiety

Of course, as I should have realised, Anxiety likes to have the last word, horrid sarcastic words that sting and endure. Anxiety showed up with bells on for the rest of the last week. I’m still trying to ask it, as nicely as I can, to get the hell out of town.

Talking about depression while pretty ill with it, on BBC London

So in case you read my Metro blog and thought I have only a humorous view of anxiety, that’s not true (would that I could see it from just that perspective, would that it never got any worse than the quirky behaviours I mentioned in that piece). There are many more serious things that come out of an anxiety condition. I will never stop making fun of myself for my quirky traits stemming from anxiety, but I will also take seriously the symptoms that debilitate me and that I must address if I am to have a chance at handling this condition in the longer term.

Tuesday 1^st September

I smiled when I heard colleagues in the elevator already exclaiming pressure over too many activities and an overextended "to do" list for a four day week. I had been careful with my planning and thought I could handle it. Anxiety doesn't care about my good diary management, though, it prefers when I over book myself to turn up unannounced.

I suppose I am only providing it with good reason to show up at those times. It's when I've made every effort to plan my week sensibly, though, that it is most annoying to experience. And despite making fun of my experiences of anxiety in my blog for Metro this week, and my firm belief that it's good for me to be able to laugh at the silly things I do because I suffer from anxiety (and, as I've said before, my medication escitalopram happens to affect me with anxiety as a side effect. Great). I'm changing to a new type of medication - which will be the sixth anti-depressant I've tried in 15 years. Hey, at least I still have new ones to try!)

For the very reason that today - Sunday - I'm still feeling pretty anxious and ill - I've written a blog that again is fragmented, because I can't calm down or focus long enough to feel able to write something consistent. What I can do is present something that is true - the peaks and troughs (panics and peaceful moments) of how a week with anxiety has been, for me.

These all resonate for me. It's amazing how physical the body's repsonse to anxiety is.

I can understand the sense of these repsonses in a situation of real danger. But attending a social event or a meeting? These symptoms in these situations are debilitating and (literally and figuratively) painful.

Friday 4^th September

Although I ate a salad for lunch today it may as well have been uncooked pastry or carelessly mixed cement, as far as my body is concerned. In my chest, among my main arteries and the networks of veins connecting my rapidly beating heart to the rest of me is a cold, glutinous congealing mass of something sticky that has got in there and won't budge. It nauseates me to the point where I push random fingers into my chest to try to find it and remove it; it won't go. I am breathing in and out slowly and deeply but still it doesn't move. It isn't digestible but makes me try to remove it through swallowing, gulping again and again without success. It isn't expiring with my outward breath. It is so constant that I hardly wonder why a couple of years ago I barely noticed it was there every day. This is one physical manifestation of what my anxiety feels like.

I times I bruise my chest by pushing at it trying

to shift what feels like a hard lump inside

I'm one of the lucky ones who isn't anxious all the time. In my past life living alone in New York in a very pressurised and stressful job, as I realised today when I felt the physical symptoms described above, and realised it had been at least three days without a let up.

This happens to me again and again, so I have

 to step in and stop it until I unravel completely

The worst time this happened was at my job interview for KPMG. I was really, really ill at the time with depression / anxiety. I have always made the effort to ignore my anxiety and go for things anyway (I suppose, that cliche "Feel the fear and do it anyway" applies perfectly to one of the ways that I operate (see below - overcompensate), It was in the very first exercise that I was presenting back to a large panel at my assessment centre when I needed to refer to the consulting firm in a 'mock client proposal pitch' that the word "Del- " (Deloitte) slipped out of my mouth in my mock-confident pitch patter. Even though the director observing said, "We'll pretend we didn't hear that", I was absolutely horrified. 

Me at my interview in reality. 

How I presented myself at interview. 

Hiding behind a suit and a smile

Every physical response - the fight or flight mechanism in its rawest form - suddenly invaded my body and overwhelmed me. I felt dreadfully sick and wanted to leave immediately, but it was only 10am and the first part of a whole-day interview. I couldn't leave. I had to stay. My brain does not work properly in a period of intense anxiety. My brain needed to work for me to get the job. Worry. Stress. Sweat. Nausea. Trying to ignore all of these and carry on through other case studies, partner interviews, even through 'lunch'. I have no idea how I got the job given how unwell I was. I did go back for a final interview another day, and at that point I was not in the primal phase of panic, thank goodness.

I now try to deploy the measures that I've learned can help of course. I do breathe deeply because at least I can reassure myself that there are genuine physical and mental benefits to this, even if it doesn't remove or lessen my anxiety: I know rationally that I'm supplying my brain with oxygen, which means that I am giving myself the best chance of being able to think and operate even though I feel physically so unwell.

I do practise mindfulness, which means I put my brain to work focusing on things other than the physical feeling of anxiety. It's a distracting technique that requires effort and a discourse with my brain where I ask it to pay attention to a single thing at my command, and politely wave or tap it in the shoulder when it drifts off to thinking about the fact that I need to send off the proposal tomorrow, that I need to go for a run, to the bank, to get the car through its MOT and buy more loo roll and answer my emails and update my time sheet and so on and on and on.

It is hard for me to practise mindfulness lying down without falling asleep- largely because if I do manage to get my mind to focus on some one thing then my brain has a chance to sense my body's total exhaustion and takes advantage of the time to shut down and rest. I have to try to sit up, and then I struggle so much to keep my mind on one thing, even for ten minutes. In anxiety I find my mind rushes here and there and everywhere but on the body scan or shape to which I'm meant to be paying attention.

Also I know mindfulness is what I should be doing, but mid-anxiety I find I often feel overwhelmed and that in adding mindfulness to my list of things to do I will cope even less well with an even longer list of expectations.

However, “I should I should I should” isn't helpful. I need to be well. I need to look after myself. I need to provide some comfort and support to myself.

Saturday 5^th September

I am now sitting here on Saturday evening wishing today had been what I thought it might be: an anxiety-free day. I’m not working; I haven’t had to spend ages cleaning the house or doing other admin chores; I even went to have my hair cut (which is usually enjoyable not stressful since I see the same person each time). Unfortunately it hasn’t worked out that way, and the physical nausea of my anxiety, my shakiness, my racing thoughts, and every other symptom, are still with me to quite a significant degree.

What else do I do when I'm anxious? Panic. It is not an exaggeration to say that it affects the brain in the same way as if there were a genuine fire, an attack or another calamity.

We are programmed to respond primitively in these situations and what that means is a release of adrenaline and cortisol to the brain. This allows us to flee or fight- giving us a spur of energy and stamina for a period of time. What happens to me is that this reaction occurs when I am in a variety of situations where this is completely unhelpful. In place of the rational person who can make decisions and lead teams, organise the house sale, my career, my blog and volunteering, among other things, appears a vastly debilitated version of myself, paralysed by fear and stress to the point where rational thought is almost impossible and the ability to do anything other than flee (whether from the office or under the duvet or whatever) is massively limited.

It repeats and repeats and repeats unless I work at fighting it. 

Unfortunately if I'm already exhausted by it it feels an impossible task.

I have to soothe myself first. Breathe, rest, walk, eat, take a moment. I can’t do anything until that’s done. When it is, that’s when I can do is split things up into manageable chunks. Maybe one small thing from the to-do list. The one thing I can do. Then the next. Then the next.

Sometimes it's more like 25% calm. At that point I could potentially achieve something.

Beforehand, nothing's going to happen unless I bring my anxiety levels below 80%

I do these when the countering, healthy behaviours I know are better but which are just too bloody hard to do at times. The closest I come to helping myself when I’m really panicking is – at best - to climb into bed and shut out everything that is causing me such stress and worry.

Also, no caffeine. I have caffeine once in a while, but 

any more than once a month or so and it negatively affects my mental state

I’m trying to learn to do this in advance of anxiety reaching its full force. I know that I am prone to pushing myself so hard in many directions that anxiety can paralyse me. I have to try to plan ahead so that I’m less likely to have an anxiety attack with the above, with a balance between work, life and rest, with the right amount of exercise (not too little, not too much).  

Sunday 6^th September

I made it to today. Doing the right things today were: 

1. Going for a run and loving seeing the deer. (Exercise also helps digestion, raises my endorphin levels, uses up some of that nervous energy, and gets me out into the fresh air to breathe.) 
2. Eating lunch with my husband. Burgers. Chips. Chat. 
3. Having a rest: this is controversial (as sleeping during the day can disrupt sleep at night), but since I cannot catch up on tiredness at any point in the day during the week, it's a real luxury for me to be able to lie down and read, watch a film or listen to a podcast without the need to go back to my calendar and prep for the next meeting.

Bushy Park today. It was glorious, and I'm happy I made it out

 and won a small victory over my anxiety

On the other hand, the horrid lump in my chest is still there. I'm trying not to worry about it! I'm still breathing. I'm still here. Small victories, even if the war with anxiety isn't over.