Dear Stranger: My letter to the world on the theme of happiness (Mind Charity)

"Dear Stranger is a collection of inspirational, honest and heartfelt letters from authors, bloggers and Mind ambassadors to an imagined stranger. Insightful and uplifting, Dear Stranger is a humbling glimpse into different interpretations of happiness, and how despite sometimes seeming unobtainable happiness can, in the smallest of ways, become and achievable goal..."

...And when I read that summary provided on the Penguin website it seems that with the positive messages in the book, provided by the collection of writers, many of whom I greatly respect, that happiness which – to me – so often – does seem unattainable (or it does when I define it as being the end of depression) – starts to feel less vaporous.

Click here to buy Dear Stranger on Amazon.co.uk

Reading further on Mind’s website, the book describes the letters as a collection of the thoughts of a number of (named) authors, who “offer their innermost thoughts on what happiness means to them.”

After a lovely meeting today with someone who represents one of the clients which the company I work for works with to talk about what we are doing as a firm about our approach to raising awareness and lessening stigma around mental health, I offer this small missive to the world of the city, as my wish for happiness in the strange world in which I work.

Dear stranger,

This is a story about two little girls who grew up. Both began life as little girls who liked running around, reading stories and singing nursery rhymes. One of the little girls had bad nightmares, though, and found sleeping often terrifying. The other little girl loved imagination and reading and creating stories, and could sing nursery rhymes with all the actions almost as soon as she could talk.

The little girls went off to school. One of the little girls loved school, she loved painting and writing and playing hopscotch. She learned to wink from the dinner lady Mrs. Keene and loved using it as part of her cheeky personality. The other girl cried when she was dropped off at school. She didn't want to leave her mother and spend the day in the company of other children or adults who were not safe. She sometimes got horrible headaches and couldn't wait for the day to be over so she could go home.

The girls went to junior school. The first little girl wrote a poem about a daffodil which was put up on the wall. She learned to play the piano and the trumpet, she sang songs in the playground at break time and played ball games and elastic band games and cats' cradle. She made lots of friends and had great fun learning to roller skate, ballet (and then giving up ballet because it was boring to "point and close" on and on), ice skate, horse ride and take part in the school's winning speech and drama group. She could run and swim really well. Breast stroke was her best stroke. Once she showed all the other girls how to do it because her teacher singled her out as one of the best swimmers.

The second little girl was scared of the playground. She was made to stand on the playground wall all break time by three older girls and wasn't allowed to get down. It happened every playtime and in the end, she pretended to be ill and asked for permission not to go to school. She didn't say why. Her parents didn't find out for a while that she was being bullied. Aged nine it happened again with a different bully. The second little girl thought it was probably get fault, because she had, after all, been bullied before. She started to believe there must be something wrong with her. She also couldn't breathe very well and often felt too tired to go to school. Eventually she was diagnosed with asthma and started to have trouble with sports.

At senior school the first little girl made more friends and enjoyed the new clubs, the different subjects and the new uniform. She made sure she understood the right tights to wear, the right shoes, bag and everything else. She went to sleepover parties and pool parties and all sorts of other parties. She met boys at the boys' school, and enjoyed life in the "big" school. She found it exciting to be growing up. She enjoyed swimming and drama, she loved going to the cinema. She didn't always work hard at all her subjects but she still did pretty well in her school exams, especially in English and Latin, her favourite subjects. Her teachers told her she was doing well and could do very well. She knew she could do well enough in the subjects she cared about and she didn't try too hard at the other subjects because she didn't want the teachers to push her too much and stop her having fun.

The second little girl found it hard to adjust to big school. She got very tired and overwhelmed by all the new teachers. It was hard to learn every different teacher's sets of rules. It was hard to manage all the homework. She found it frightening and tiring to be growing up. It was hard. She found homework confusing and exhausting at times. She didn't get top marks in her exams. Sometimes she did badly. Her teachers told her she wasn't working hard enough. She needed to work harder. She tried to please the teachers but sometimes she found it too hard and because she didn't concentrate in lessons or understand everything, and because she was often too ill with asthma she had to go to hospital and she fell behind.

These little girls have different lists of achievements, as you can see, and on they went. One of them went to university and got a degree. She got a job with a prestigious graduate charity and then a job in the city, all in her twenties.The other one had health problems with stress, grief, depression and anxiety throughout her twenties and got a degree with difficulty. They both fell in love with a wonderful man, but one of them - now a young woman - seemed to find it easier to have a great time and enjoy every moment together; the other young woman was plagued by anxieties about herself and worried about their relationship frequently. One was promoted several times at work, worked internationally and was recognised a number of times for her achievements; the other found the depression returning at intervals and spent some holidays resting in bed for fear of confessing her illness to a world she feared would not understand, and because she could not accept the weaknesses and failures she saw in herself.

So, reader, what do you think happened to those two little girls? As you have probably guessed, because you are wise and discerning, and used to stories like these, those two little girls were one and the same. In fact those two little girls grew up to be me.

Now you will say to me, "Writer, you have not told a tale of happiness, which I thought was your purpose?" And I will say this to you: I read my own story back again and again, and I remind myself that I am the happy little girl alongside the sad; I am the confident high achiever alongside the shy, fearful and tearful teenager. I am the woman who has made a successful career in spite of suffering episodic depression, anxiety and trauma. I am she. 

When I need a reminder of the definition of happiness, I can look at parts of my own life. (And when I want a reminder of sadness and hurt, I can do the same, but enough of that for now.) I shall celebrate the happiness when I can, and be thankful for every happy moment past, present, and yet to come. And throughout my life, as you have seen, there have been threads and strands and patches of happiness, alongside any sadness you may see or know of. So, please, dear stranger, remember that. And lastly, I wish a wish for you: yards of happiness of your own, among all the threads of sorrow. Keep looking backwards and forwards for happiness because it can and will find you, somehow, somewhere, and treat others with the kindness that you try to show yourself.

With love, Jessica

Marvellous Medicine? What is Private Hospital Care for Depression like?My Week.

It’s the end of my week off, hospital done and back to work next week.

Tomorrow I’ll be writing another #dayinthelifeMH post, and adding it to others’ contributions, but in this post I’m reflecting on my experience of taking time out for my depression (as I knew I needed to), seeking treatment for it, and going back to normality (whatever that means – I guess work and living) afterwards.

"Okay, I need help, time to take the mask off for a while and deal with this."

My experience of hospital is of private treatment for mental health patients with a variety of conditions, and it’s private because I am incredibly fortunate to be able to work for a company which provides, as a benefit, private health insurance. I can’t talk about public healthcare for mental health as I’ve never had it (see previous post for more details). What my private mental health coverage means is I have a psychiatrist and a one-to-one therapist I see, and in-patient or day-patient treatment which I can also make use of – depending on the severity of my depression at a given point, and also a fair amount of paper work which my psychiatrist, therapist, key worker (another therapist with whom I make appropriate treatment plans) and others complete to make the case to the insurance company that I should get approval for the treatment we believe I need.

Thanks very much, I'll take all that money from you right now...I need treatment

I knew that I’d be struggling after last weekend and a variety of external matters contributing to my worsening depression, so I took the step to see my psychiatrist beforehand and ask for the paper work to be submitted requesting day care at hospital for a couple of weeks (because it’s always easier to ask for more upfront than go back and ask for more later). Luckily my case was accepted and covered by my insurer. It’s not possible for me to pay for it privately, even on what I know is a really good salary. It’s just too expensive – something like £500-700/day, which, to be honest, if I were well I’d far rather splash out on a new pair of gorgeous Louboutin shoes as a massive extravagance (and a one off, not 5 pairs in a week, although if I ever win the lottery…).

Shoes fit for any Superheroine

The fact is that I might be able to pay for just one day of care at this amount, but I just wouldn't be able to pay for more, without going into debt. Money worries have always been a contributing factor to my anxiety and depression; when teaching I couldn't afford to feed myself without using my credit card (on £17K/year with London rents and prices) and I longed for a day when I would be able to pay my bills and eat, and socialise, without getting further and further into debt. Now that time has come, I feel physically sick at the thought of going back to that place. I cannot go back there. It would certainly worsen my health – probably both physically and mentally, as I know they’re connected (and I describe below).

When Depression Debbie comes calling, she's packs a punch.

Anyway, to hospital. My experience of private day care (as opposed to inpatient care, where I would stay in hospital) is to travel to hospital from home and to attend a number of groups every day which aim to educate and support people like me going through a difficult period of mental illness, whether that be depression, anxiety, PTSD, bipolar, borderline personality disorder. I attend groups which my keyworker and I determine will best suit my needs.

Time for support group. Let's share our troubles and support one another.

The first group of the day is support group, where I and other day patients sit in a confidential environment to share how we are feeling, what issues we’re struggling with that day and what we think we will do about them. We have to go around the room to introduce ourselves and ‘check in’ with our state of mind and feelings. This is helpful since many people are ‘new’ to the group each day. This really all comes down to insurance – if you’re covered for a particular day you turn up that day but not on days when you’re not covered. In the last week I met at least twenty people I had never seen before (and a couple I already knew). We are all taking what we can get. The people I met varied every day, so there’s always something new to talk about.

Time to fight our illnesses together. Pow!

In the hospital environment, the support group is guided by a therapist – in our case the therapy manager – and this helps us to dig a bit deeper with the problems that we’re overcoming, whether our illnesses have been triggered by a family matter, work, other pressures or a mixture of all of these. I love support groups because I don’t have to take notes or apply particular therapeutic techniques, but sharing with others is a kind of release, and hearing and participating in group discussions about issues often help me to unpick some of my own personal struggles and find that I am not alone or that I have new options I had not previously recognised.

Hello Demon Difficulties. Please go away.

The other groups are harder. This week I attended a schema group, which educates us as to our core needs as “newborns”, and how our core needs (whether met, overly met or not met) lead us to ‘maladaptive’ coping strategies – i.e. things that we do to compensate for whatever our upbringing and childhood environment was like. For me there’s a lot to learn about the way that I behave now as an adult which links back to being bullied as a child and feeling isolated. It is fascinating and useful, but it is also very hard to think back to those times where I was in so much pain and had no means of understanding or coping with the situations into which I was placed. You can make friends at hospital - because you may bond with others. It's a matter of choice, though, because if you do make friends you often talk more and more about your and their struggles, making the experience more intense and potentially tougher.

Memory Lane. Tough as nails and stronger than steel. And ever growing.

Other groups look at cognitive behavioural techniques (conscious recognition and rational working through) for anxiety, depression, and other important areas like anger management and assertiveness. Practising recognising our negative feelings and the ways that we automatically respond to them, and hearing how to apply different thinking patterns to try to retrain ourselves is what we do in this group.

I can see you, negative thoughts. I'm ready to fight.

For example, if I text a friend and don’t receive a text back, the lonely and isolated, bullied child in me might apply an automatic response, linked to our old ‘fight or flight’ mechanism. I don’t receive a reply = I’m somehow in danger of getting hurt here; = My friend doesn’t like me anymore; = I’ve done something wrong… and so I start to become anxious because of these worries and start becoming  depressed as I wrack my brain for potential incidents in the past where my behaviour might have caused the person to dislike me. (The first – worry – leads to a build-up in anxiety, as the physical symptoms like a racing heart, feeling sick, feeling dizzy may strike in addition to the ‘cognitions’ or thoughts that I described above leading to the feelings – shame, guilt, fear, etc. The second – rumination – leads to increased depression and may include some of the physical symptoms above, but also add sluggishness, a feeling that one is hopeless, a failure (more shame, more guilt, anger at self and others, fear of never getting better.)

In this case, 'A' is very much for 'Anxiety'

When I read the above and tell you that attending these groups leaves me feeling exhausted, I hope that you are not surprised. It’s quite hard for me (and I think it’s hard for others) to acknowledge in the first place that I need help of this level. Unfortunately the part where I get help is far from easy, as I look to past events and their effect on my feelings and depression, and I have to recognise them and confront them in order to start working through those feelings and events to feel better.

I went through this on Tuesday, Wednesday and Thursday, always attending the support group first thing, and following this with other groups. By the end of each day I am drained and sad, probably sadder than I was when I arrived, because it is hard to go through things from the past. However, the alternative – not to go through those things – not to challenge my past and my negative thinking – not to address the deep depression that is overwhelming me – is not to live. And since I choose to live, I choose to get help, even though it’s hard and afterwards I curl up in my bed under the duvet, with pillows all around me, and I tune out with Netflix or my Kindle, or with a radio programme, and perhaps go to sleep for a while.

Support group. Where we share and sometimes laugh together. 

It's good to know I'm not alone.

I took Friday as my last day before returning to work. I didn't go to hospital because I wanted some time to do more tuning out and re-acquaint myself with the land of the living, thinking a bit about work, doing some food shopping, posting some parcels, paying bills and so on. I also spent a good deal of time cleaning (which is surprisingly therapeutic as a physical activity that allows me tune out) and resting in bed with a book. It's also just good not to think about myself in such a focused way - not to work on myself anymore. It's a relief to stop that and necessary in order to dip into a week of treatment and then return to work immediately. For me, Friday was the opportunity to start back into life and lead into the weekend with rest, and with those sad, terrible thoughts not exactly put away, but left for a while to get some air and be revisited in a smaller way at a later date.

And time for sleep while that works away...

I now feel like I’m ready to work again, and I feel rested, and heard. On Tuesday I felt hopeless; on Wednesday more so; on Thursday tired by the whole thing, and on Friday relieved to be away from all that difficulty, but able to recognise its value. I could see the sun and smile quietly at it. I could walk and appreciate the wind (and drizzle!) on my face and be in the world without anger or self-hatred. It’s a step forward. I will keep stepping forward. 

Time to step forward.  And put my head band and shield back on. Obviously.