Walking up THAT hill? The mental health benefits of walking

When Peter Gabriel wrote Solsbury Hill, he’d had enough of the music industry and being part of the band Genesis. Right from the off, this is a song that is going places and takes the listener with it. I associate it with change, and a feeling of hope. There’s an upbeat sense of purpose to the guitar intro that says: keep up, we’re going somewhere good, if you want to come with us. There’s also a delightful clip in the video which features someone – it may well be Gabriel himself – picking cabbages. Surely a first (and last) in the history of pop music videos.

This song also makes me think of being in the countryside and walking up hills; something that I enjoy doing with family and friends. Even without Peter Gabriel singing about an eagle that ‘flew out of the night’, there’s something magical about savouring a great view from the top of a hill you’ve climbed yourself. Admittedly, it’s dispiriting when you can’t see the view because of thick mist, but it’s joyous on a sunny day to feel on top of the world as you look out across miles of rolling countryside.  Much like looking out at the sea from the shore, such a view puts everyday worries into perspective.

I owe a lot to walking, both in terms of my personal life as well as my mental health. Without it, I doubt I would have met some of the most important people in my life, nor found a free and easy means of both transport and mood enhancer. There’s lots of evidence that being in the outdoors is good for our mental health. But walking anywhere (safe – being mugged, I would guess, is not so great for your mental wellbeing) can be a great way to clear the head. Even Nietzsche is reported to have said that “all truly great thoughts are conceived by walking”. I don’t imagine him to be the cheery, ruddy-faced outdoor sort, though I could well be confusing him with café-loving Sartre, given my scant understanding of philosophy.

Anyway, there’s something about depression in particular, and mental ill health more generally, that makes us turn inward and lose sight of the outside world. Just the sheer act of putting one foot in front of another means we are making progress of some sorts. On some days, just getting out of bed and through the front door, dressed in something vaguely presentable that doesn’t have toothpaste down it, can feel like a finishing a marathon.

Walking is also a great way to talk through an idea or a situation. The rhythm of walking and talking is ideally suited to putting an idea into perspective, as well as getting to know someone else. You’re in control of where you go next. Unlike most forms of transport, you are master of your own destiny and not hindered by cost, road works, defective trains – or that most depressing phrase, a ‘rail replacement bus service’. If you do get lost, it’s down to you to fix it, and if you were to join me on a city break, I’m reliably informed that my map reading will mean a ‘short cut’ might take more time but always lead somewhere interesting.

As a teenager, I used to moan about hill walking being pointless. Which, to a certain extent, it is. At one level, you can’t argue with my teenage logic that could see no point in going up a hill just to come down it again. But such thinking is rather bleakly reductionist. There’s more to hill walking than the sometimes tedious business of walking up them. After all, why eat nice food, if all you are consuming it for is for the nutrients? Life without joy is just existence, and indeed is a good description of the all-consuming greyness of depression. I think I’ve said previously on this blog that though I’ve not taken them myself, anti-depressants are surely anti-misery, not ‘happy’ pills. Depression is not the absence of happiness. It’s the absence of any normal ability to feel human emotion, good or bad.

Sometimes a half-hour walk round a local park is a good way of starting to fight back against the darkness. It lets in a bit of light among the gloom, and can be a way of making that first bit of progress. Walking can’t pay your bills, guarantee you a partner, deal with your bullying boss or tackle the concrete causes of stress in your life. But it can help your mind start to think of itself as an organ that is capable of dealing with such stresses and strains. Not bad for something that is free and that we often do every day without even thinking about it.


Food, glorious food

I have a memory of looking in the mirror one day and seeing a puffed up face and dry hair around it. It must be me, because I’m the one looking in the mirror, I thought. But who is she, this numbed-face stranger, looking back?

This fragment of a memory has been filed under ‘thing that must have happened while I was in hospital’. It was probably around the time when I was on some sort of medication that sent my blood pressure so bananas I couldn’t get out of bed because I would get so dizzy. Just one of the legion of side effects that psychiatric medication can have.

By and large, I’ve been very lucky that the medication I take helps me and doesn’t knock me out too much. It does mean I put on weight when I first started taking it – about half a stone – and affects my appetite.

Like many people, I have a complex relationship with food. At university, I lost weight during my first term because I had got used to excellent home cooking and the food provided by halls was cheap and unappetizing stodge. I remember a fellow student asking me why I didn’t each much. It’s not something that anyone has said to me since then!

I’m much more likely these days to comfort eat than I did then. A few years after I graduated, I had a temp job and got chatting to a colleague who was very overweight. She had had a Mars bar with her lunch, and was, in a melancholy way, telling me that at least this time she hadn’t eaten the entire multipack. At the time, I thought this very odd – how could anyone eat more than one Mars Bar at a time? – but these days, I can understand why people overeat.

A great song celebrating the bigger woman!

Addictive or comfort eating is often a private vice that becomes very public if you put on weight. Too much excess weight, and it can be seen as a weakness, lack of self-control or just plain greed. And while all those factors may be true, there are lots of reasons why people stuff themselves with food they know is doing them no good. Most people know what healthy food looks like, and that we should eat five portions of fruit and veg a day. We often choose not for very complex reasons.

Sometimes, we eat our feelings. If you’re angry and in pain, and don’t feel you can handle it, a chocolate bar can be both comforting and a way of burying the feelings by adding to the layer of comfort food that buries the difficult feelings. It seems to me that women are not socialised to get angry or shout. If a woman loses her temper at work, say, and shouts at people, she’s ‘unhinged’, ‘unbalanced’, ‘hysterical’ and generally loses credibility. If a man does the same, it usually won’t be socially acceptable but however negative it is, it will be seen as an extreme example of masculine strength. Men are, supposedly, ‘just different’ when it comes to getting angry.

There’s an argument that this ‘difference’ is why women judge each other on their appearance and ability to make friends. We’re not supposed to get competitive but we certainly judge each other on our appearances. Men, it seems to me, are much more transparent about their competitiveness. They accept a degree of jostling for the top spot as being normal. Women – and particularly – girls are supposed to ‘play nice’ and be soothing caregivers. Get angry and shouty, and well, you aren’t very ‘feminine’, somehow.

So what to do with those angry feelings, if society tells you they are not nice or ladylike? Become a judgemental-jellyfish-bitch type of woman, and put other people down to make yourself feel better? Bottle up the feelings and then wonder why they explode, sometimes? I had a therapist who was always encouraging me to connect with my feelings, however painful, so that they would pass. She would say that it’s only be acknowledging and understanding how we feel that we can stop being controlled by our feelings.

And of course, she’s right. It is the best way. It’s just that sometimes, the siren call of comfort food is too hard to resist. It’s available everywhere we look, and feeds an addiction that is very hard to kick. While I do recognise myself in the mirror these days, I sometimes wonder how I can kick the habit of dampening down difficult feelings through eating. Because we do need to eat, and so not quitting isn’t an option in the same way as smoking would be. It’s an area I’m reading about and hope to control more effectively in time.

How do you deal with difficult feelings? Do you comfort eat? Or are you one of those lucky people who can keep apart your emotion and appetite, and not eat another bite once you are full?

Nevermind the shrinks, what about the aftercare?

The first psychiatrist I ever saw had very shiny, black shoes. Throughout the six months or so I saw him for what I think was a weekly appointment, I barely looked at his face so I can’t remember what he looked like. But the shoes stay with me still.

He had wide feet, not quite clown shoe-sized but certainly big enough to suggest he was flatfooted and easy to hear clomping down a hospital corridor. These were smart black shoes that were lovingly polished and cared for. He would talk at me, seemingly for hours at a time, and I would say very little back with my eyes fixated on the floor around his feet. It can’t have been a very satisfying experience for either of us.

One of the common clichés of mental illness is that if people would ‘just take their medicine’, somehow the mental illness will go away. Of course, that just isn’t how it works. Some people spend years trying various different combinations of medicines, only for their symptoms to remain as stubbornly as if they hadn’t taken anything. I’ve been lucky that the medication I take, which Nirvana happen to have written an excellent song about, really works for me.

So yes, advice to ‘keep taking the pills’ is important, but there are limits to what it can do. I find it very frustrating that people who don’t understand how mental health services in the UK work can often assume that taking medication is enough, somehow, to ‘keep the crazy contained’. You often see this in the news reporting of rare occasions that someone with a mental illness murders or kills people. Inevitably, conclusions are drawn that this person should have been drugged up and in hospital. The more complex truth that often people have begged for help before committing such a terrible crime is harder to swallow.

Medication can’t entirely eliminate the reasons why someone gets ill in the first place. Physical or sexual abuse, say, or living in a home that isn’t safe or properly heated. The best antidepressant in the world can’t get rid of the bully at work who is making your life feel unbearable.

It’s fair to say I see the profession of psychiatry in a sceptical light: it absolutely has its place in treating sick people and getting them back on their feet. For that, we can certainly praise it and all the dedicated people who work in it. Indeed, psychiatrists themselves are still, I believe, known as ‘psychos’ by their fellow doctors, and they would have had far more power and esteem had they specialised in another form of medicine.

But psychiatry in the UK is, in my experience, very limited in what it can do to actually help with the day-to-day stuff of life. It’s a bit like mental health A&E for a broken leg, and if you are lucky, your local NHS services will be on hand to provide talking treatments that are the mental health equivalent of physiotherapy. But far too many people have to wait years to get the kind of secondary care that would be available much more quickly for a physical health problem.

Psychiatry is, to my mind, a deeply subjective and often uncomfortable process. I have heard of a male psychiatrist judging female patients’ state of mind based on how much make-up they were wearing. As if whether or not you bother to apply blusher is a good indication of your state of mind! This particular doctor was fond of sporting jackets with corduroy patches on his elbows, so he was hardly ‘fashion forward’ himself.

I remember one psychiatrist getting very defensive with me when I told him I worked for a mental health charity. “I suppose you think you know more about bi-polar than me”, he said, in an aggressive tone. “Oh no”, I said, “Not at all”. What I wanted to say was: “Actually, I sure as heck know more than you about my illness, seeing as how we’ve just met and I doubt you’ve had time to properly read my notes.”

But I said nothing, fearing being labelled as a ‘difficult’ patient. God knows there enough labels in mental health without adding that one to my notes.

What’s also quite telling is that stigmatising attitudes among health professionals have been some of the hardest for the Time to Change campaign to shift. I suppose if you only ever see people at their worst, it’s hard to think of what they might be like at their best.

Maybe that’s because so much of mental health care is about containing risk and harm. And very important that is too. But what makes me frustrated sometimes is there seems to be very little emphasis on thinking positive and expecting people with mental illness to make a good recovery. Why shouldn’t someone with a diagnosis of schizophrenia hold down a demanding job? With the right support and a gradual stepping up to more responsibility and pressure, surely it must be possible? And yet this risk focused culture can sometimes make such high expectations seem as delusional as psychotic symptoms.

Fortunately, times are changing. We have a government – finally – pledging to reduce waiting times for mental illness. How on earth that will happen is anyone’s guess, given the state of the NHS budget, but at least the intention is now on record.

The penny is slowing dropping that people with mental illness are in work, have families of their own and are fine, upstanding citizens, given the right support and chances. Many people working in mental health do so because they really care about their work and want to help people get better. With politicians talking about ‘parity of esteem’ for physical and mental illness, attitudes do seem to be shifting. Hopefully one day, telling a colleague that you’re seeing a therapist will be as significant as seeing the dentist. Because ultimately, talking about our health is not necessarily fascinating conversation all the time – much like hearing about other people’s dreams, it can be pretty dull – but the stigma of mental illness can be a heavy and very private burden to carry.

Having to keep your mental health status a secret is, I imagine, much like being gay and having to be constantly vigilant about who you feel you can tell. Bringing things out into the open makes them less of a big deal, and much easier to put into perspective and manage. And an open and inclusive society is good for everyone, surely.

Bonkers: why mental health language matters

It’s the mid 1990s, and I’m meeting some strangers in a pub. We are discussing an idea I’ve had for a ‘Mad Pride’ event. I’m young, naïve and it soon becomes clear that I’m out of my depth. My attempts to organise some kind of event to inform young people about mental health issues illustrate that I have no idea how to organise something as ambitious the vision I have in my head.

The people I’m meeting include Pete Shaunessy, a mental health campaigner who has much more experience and knowledge than me about the politics of mental health and campaigning for change. The meeting doesn’t go well – and he walks out of the pub part way through the evening; frustrated and annoyed.

I later found out that Pete Shaunessy was a leading light in the Mad Pride movement. Twenty years on, I look back at my youthful enthusiasm and naivety with a kind of maternal pride underscored by amusement. Even my psychiatrist wanted to support the idea me and my sister pitched to him, but the cheque from his personal bank account remained uncashed as we were unable to get our grand plan off the ground.

Pete Shaunessy sadly passed away several years ago, but the notion of Mad Pride continues. It’s what you might describe the ‘Angry Activist’s reaction to society’s attempts to categorise people who experience mental distress. Mad Pride uses the social model of disability, which says that it’s not me, the person with a mental illness, who is the problem. It’s society’s response that is.

A confession: I am not really the angry activist type. I’ve been on very few demonstrations in my life and am far too cautious to be much of a radical. While I can completely understand and respect why some people do, I wouldn’t say I was proud of having a mental illness. It’s essentially a thing I have that I need to manage. Nonetheless, the language of mental health matters to me.

There is so much negative language about mental health, and precious little positive vocabulary. Think of all the words and expressions there are to describe mental distress. Bonkers, dolally, crazy, psycho and mad. A sandwich short of a picnic. Not quite the full shilling. Bats in the belfry. There are almost more words for having a mental illness than there are diagnoses. And calling someone mad, or loopy, can be a term of affection and but is often an insulting way of dismissing someone.

Words are how we describe and define things as well people. Getting the words wrong means we are misunderstood, or we can’t communicate. Words and definitions matter a lot when it comes to mental health issues. If you don’t respect other people’s way of describing themselves, it can mean you are, essentially, telling someone you know better than they do who they are and what they have. And when you have lost yourself through psychosis, and fought hard to rebuild your life, who you are matters even more.

That’s why I say I have bi-polar – but I am not it. It may seem like pedantic semantics but it matters to me, because I do not want to be defined by one label. I am also a Christian woman; a wife who co-owns a house and has a mortgage. And a big fan of all sorts of music; from Hall and Oates to Ace of Spades. But each of these labels only tells you about one part of me, not the whole.

That’s why I love Bonkers. The chorus, at least, sounds to me like an unapologetic and defiant celebration of being who you are and not being defined by what other people think you are. I think of it as reclaiming a word that can sometimes be a put-down.

It’s also a great dance song that I associate with some wonderful nights out. For me, there’s nothing quite being with friends, on a busy dancefloor, when the right song comes on. I love dancing and find it one of the best ways to let rip and be creative. I like to think my dancing is pretty good. Apparently,though, not everyone feels the urge to use the classic aerobics steps known as the Grapevine while dancing to the Stone Roses. More fools them, I say.

So while language matters, there are times when negative expressions can be reclaimed. And in any case, the ‘appropriate terminology’ will still sound like an insult if someone who thinks of themselves as being PC wants it to. Ultimately, it all comes down to seeing the person, not the illness and not using negative terminology to reduce them to being nothing more than a diagnosis. And thank goodness things have improved in the last 20 years. Other people and organisations, like Time to Change, have had the same vision I had of organising mental health awareness events for young people – as well as the resources to make it happen.

Robin Williams, suicide and sunshine

If you or someone you know is experiencing mental distress or suicidal thoughts, the Samaritans are available 24 hours a day, 7 days a week. Call 08457 90 90 90 (UK), email jo@samaritans.org or visit http://www.samaritans.org

The recent death of Robin Williams was mourned by many, many people who had never met him and yet felt that they had. He was, in a way, like a crazy uncle bringing fun and zaniness to tedious family gatherings. Whether he was a childhood memory through watching Mork and Mindy, or we knew him through his joyful, incandescent comedy, he was much loved and is much missed.

One of my own favourite moments is in Good Will Hunting, in which Williams plays a kindly therapist who is treating Matt Damon’s character Will Hunting, an extremely talented and troubled young man. There’s a scene where Williams just keeps softly repeating, ‘it’s not your fault’. Will crumbles, all his macho posturing evaporates and he opens up. We never really find out what Will has been blaming himself for, but in that moment, he seems to stop. This song is from the film, and somehow the melancholy tone feels right for a consideration of what drives a person to take their own life.


There was also widespread shock that someone with so much wealth and status would take their own life. Being wealthy undoubtedly makes life easier in some ways. Yet people who win the lottery tend to stay as happy (or sad) as when they first get their payout. So while poverty is clearly no picnic, wealth doesn’t insure against unhappiness or mental illness.

It’s easy to think that suicide is not so much painless, as the M.A.S.H. theme tune has it, but selfish. How could a person choose to die over being alive and loved by people who are now left with such a brutal loss and grief?

If people have this attitude towards suicide, I envy them. It tells us they’ve never experienced depression, or been close to someone who has. Although I’ve never tried to take my own life, or thought about how I would do it, there have been times when I have been so low that I could see that, rationally, a way out would be to stop living. Fortunately, the depression was never bad enough for me to do anything about this option. I’ve always felt that there were other ways out of the hole I had temporarily found myself in. At some fundamental level, I have known that dying was not the answer to the depression I was experiencing.

Perhaps a helpful analogy is to think of suicidal thoughts as being like a crocodile. They silently sneak up on their prey, pull it underwater and spin it round until they die. Suicidal thoughts can render someone so distressed and disorientated that they are convinced the only way out is to give in.

There is also a lot of fear of talking about such dark and distressing thoughts. We might assume that doing so makes it more likely that people will act on them. The last thing we should do is shut down discussions about suicide if someone we love is talking about ending their life. It’s understandable to be scared of saying the wrong thing, but it could be an opportunity to help by listening without judgement. People, and men in particular, may not talk about their plans to end their life before they enact them. So if people are saying something about suicidal thoughts, it could be an opportunity to help keep them as just that – and nothing more. And even if they are just ‘attention seeking’, well, maybe the distress is bad enough to warrant a little attention until it passes. And what’s so terrible about getting some attention if you are in pain, anyway?

If you’d like to find out more, the Mind website has some excellent advice about suicide. Fortunately, there has also been a lot of research into effective suicide prevention. People often end their lives on impulse, which is why we can no longer buy big bottles of paracetamol from chemists in the UK. There is evidence that the simple action of having to visit more than more chemist can be enough to help someone reconsider their decision.

We can never be sure of what was going through Robin Williams’ mind when he died. But we do know that such painful thoughts do pass, and what can seem like the blackest, most impenetrable cloud, will eventually give way to sunlight. Sometimes that can seem like the most unlikely transition in the world. That’s why we need to not be afraid of the darkest side of the human mind but to take away its power by understanding it. It’s amazing how much difference little things make when it comes to supporting someone with a mental health problem. You really don’t have to be an expert. More often than not, you just need to listen and not judge.

Nyphomaniacs, pixie dream girls – and real life

I first came across Sylvia Plath when her name was stuck to my head. I was playing the ‘Rizla game’, when someone writes the name of a famous person on a Post-it or Rizla and sticks it to your forehead. At the time, I’d never heard of her. So the first time I heard her name, it was when two people almost shouted it at me in exasperation.

Intrigued, I later read her excellent novel The Belljar. Her writing is spot on when it comes to describing the unreal, distancing and unravelling nature of mental illness. The trouble is that this Ryan Adams’ song about her is, in my opinion, symptomatic of a romantic and damaging notion of what it’s like to be ill, and what a creative woman with a mental illness is like.

There’s a lot of well-meaning but insulting nonsense, both written and spoken, about how mental illness is linked to creativity. Even if there is a link – and I believe the evidence-based jury is very much still out on that one – it’s nigh on impossible to be truly creative if you are very sick.

It’s hard to write truly great poems and novels if you have lost touch with reality, or are in so much depression-related pain you want to die because it seems the best way of escaping the bone-aching agony of living.

So why does Ryan – that’s Ryan, by the way, not everything-I-do-I-do-it-for-you-Bryan, Adams – want a sick woman to take him to Paris and get him ‘loaded on gin’? Surely it’s all part of a perception that ‘volatile’ woman are sexual bombs waiting to go off at any time? We see this lazy trope in many aspects of popular culture.

It is true that one of the symptoms of bipolar disorder is that people can lose their inhibitions because of hyper-sexuality and take risks they would never normally consider. Hey, I’m no prude, and along with my uni friends, had my fair share of, ahem, experimentation in my 20s, some of it fuelled by hyper-mania.

In TV and film, this symptom is often turned into the stereotype of a hyper, edgy and unpredictable woman wearing far too much eye makeup, a deranged glint in her eye and a eye-poppingly short skirt. She’s amazing in bed but can’t be trusted with the spreadsheets of a successful business, or the responsibility of childcare. Think of the classic 80s French film Betty Blue, or the bunny-boiling temptress in Fatal Attraction.

The more contemporary and benign version of this stereotype would be the Manic Pixie Dream Girl. A film critic coined this phrase to criticise the sexist portrayal of dreamy ‘space cadet’ girls-next-door who could rescue depressed young men from themselves through their sunny personalities. Even he now wants to retire the term, so prevalent has it become in contemporary culture.

We don’t, quite rightly, romanticise having chemotherapy or a diabetic needing to check their sugar levels. We see that as treating an illness that doesn’t entirely define who a person is. So why can’t we accord the same respect to those of a mental illness?

Look, I am no killjoy. I enjoy a good romcom as much as the next person and don’t expect my fiction to be a dreary version of reality. But Sylvia Plath was a real person, with a family. It’s disrespectful to them to reduce a talented artist to an archetype of a damaged woman who is fetished as a muse only fit for putting the world to rights over gin and Gitanes in a smoky Parisian bar. It’s also a shame because Ryan Adams’ song is, in many other ways, a beautiful piece of music, and one of many on a great album.

We need more women on screen and in music who are contradictory and real, not a character-by-numbers. Like the fabulous array of women in the movie Bridemaids, or the dark comedy of My Mad Fat Diary. Otherwise we will continue to reinforce the notion that the only ‘crazy ladies’ are either hyperactive nymphomaniacs or depressed miseries with pale skin and long dark hair, rocking quietly in corners. There have to be better stories to be told about the millions of women with mental illness than these lazy stereotypes.

Left to my own devices: making mental health work

It was a beautiful spring day, and the sunlight streamed in through the living room windows and warmed up the room. Listening to the Pet Shop Boys that day was like the starting pistol on a particularly productive burst of activity. I find music can help me focus while I work.

When it comes to work and mental health, the figures are so grim, it’s enough to make the most Pollyanna-ish of people feel less than chirpy. Ask some employers if they would hire someone with a mental illness, and you’ll find they’d rather you had a criminal record.

People with a mental illness have the highest ‘want to work’ rates of any unemployed group, but find it tough to get into work, particularly if it’s been a long time (or never) since they did.

My own short periods of unemployment were cushioned by a lot of family support. I’ve been privileged not to have to pay the rent when I was in my 20s and doing voluntary work to get into my chosen profession.

I do know that signing on was one of the bleakest experiences of my life. It’s up there in the Top 10 of Horrible Moments in my life so far, along with being a psychiatric inpatient. And going to Hull in the early ‘90s. (Sorry Hull. I’ve not been back since and I’m sure you are much nicer now.)

So it makes sense that being in work is good for your mental health. If nothing else, you don’t have to go through the Death Eater style indignity of trying to get benefits.

I think there are a lot of unspoken assumptions about mental illness in the workplace that are a very insidious form of stigma. There’s a very negative (and inaccurate) narrative that says that we people with a diagnosis are a bit delicate and vulnerable. ‘They’ can’t take the heat or any kind of pressure and will be on sick leave all the time with ‘stress’.

It leads to the Unexploded Bomb Management Technique, in which the sorry employee with a mental health issue is handled with kid gloves from as far as distance as possible, not given any direction about what they are doing right or wrong, and is generally expected to cock up. Then it’s only matter of time before they do, are permanently signed off sick, and the nightmare is best resolved by the person leaving.

Anyone who has ever worked in an office can tell you that personality goes a long way. Office dynamics often come down to whether the leaders at the top are creating a healthy environment. So if it’s not ok to make a mistake, people work with a metaphorical shield on their backs to avoid being stabbed in it. Or if the leadership style is to bully, managers may look for a scapegoat to pin the blame onto so they can hang onto their jobs. Conversely, if everyone is supported and encouraged equally, without favouritism, it makes it much easier for anyone to flourish.

In my experience, so much of what makes working life good or bad when you have a mental health diagnosis is about your relationship with your line manager. I’ve had some excellent, some decent and some downright awful experiences. As you may well have done yourself. But what makes the difference for those of us who have a mental health condition is that, in my experience, our ability to perform well is much more dependent on the quality of this relationship.

Because with the right support, the mental health issue won’t matter. With bad, wrong or toxic support, the anxiety can seep out like a horrible ‘flu virus and infect your work.

Also, there are no hard and fast rules. What works for one person won’t work for another. There is no ‘one size fits all’ approach to line managing someone with a mental health problem. The best line managers are the one who focus on getting the best from their team and expect good things to happen. I need someone to have some faith in me, provide some focus but not hold my hand. I get that I’m paid to a do a job, so I need to get on and deliver it.

My attitude to work has changed considerably since I first started full-time work about ten years ago. Back then, I used to struggle with the stamina required for a demanding job. I mentally took work home with me, and took a lot more to heart than I do now.

Crucially, I thought I could ignore office politics, but I’ve since learnt the value of keeping senior colleagues happy so that I can get on with the job without being micromanaged.

Here, in a nutshell, is what I’ve learnt along the way:

1. Be honest with yourself

This applies both to me and my line manager. I have to be confident I can do a good job to keep the anxiety at bay. There’s no point in getting out of my depth and feeling super-stressed. That may work for some people – let’s face it, usually men – but not for me. If I’ve got something wrong, I need my line manager to be able to tell me in a constructive way so I can learn from it and move on. This helps avoid the anxiety spiralling so much that I’m less productive. It’s insulting not to be clear about what you expect from someone just because they have a mental illness.

Equally, there have been times when I’ve left a job because I just needed to go. Some jobs won’t work out well, or they’ll have served their time for you. Getting out with dignity is crucial in this situation, if it’s at all possible, especially if your self-esteem is fragile and you end up in vicious cycle where your productivity is undermined by a lack of confidence and motivation.

2. Take it steady

Of course you can work if you have a mental health problem. So many people do. The question is, doing what and how? I’ve chose a career path that has gone at a slower pace than some of my contemporaries. How much of that is down to personality, ambition and confidence, and how much is to do with my diagnosis, I’ll never really know. The point is that I’ve had to go at my own pace. Which brings us onto point three…

3)    Don’t compare yourself with the ‘normals’

I have friends and former colleagues who are the same age as me or younger who earn far more and hold down much more pressured jobs. On paper, I could take on more than I am currently doing. But the past few years have been a blessing, workwise, because it’s given me the headspace and emotional energy to tackle some big life decisions. I won’t want to work at this level forever, but being able to go to work and not feel overwhelmed by the workload has been fantastic.

Sometimes, life feels to me like the fairground arcade game where you each have a horse that moves across a wooden race track. The horse is moved along by throwing wooden balls into a slot. Having bi-polar has felt, at times, like having a hand behind my back while everyone else races ahead. But they haven’t had to deal with the same things I have. So it does us no good to compare ourselves to others.

4)    Get a work support network

I am fortunate to have a group of friends who, like me, have a mental health condition and hold down demanding jobs. They ‘just get’ what it’s like to have to do these two jobs, and get paid for one of them. It’s a wonderful feeling when my worries are understood by someone who knows what this is like. Having a safe place to vent makes a big difference.

5)    Find your America’s Next Top Model (ANTM)

Everyone needs to switch off and relax. When I was doing a particularly emotionally draining job, I loved watching Tyra Banks coaching young American women who dreamed of being models. You can judge all you like, but ANTM was the perfect, vacuous TV nonsense that helped me switch off. It’s easy for anxiety to take hold, like a mental dry rot. We all need something to stop it spreading and taking over. Watching Tyra strut her stuff worked for me then.

6) Get some perspective

Above all, I’ve found it helps to find ways not to take work too seriously. Don’t get sucked into too much office gossip. It’s not real life and it doesn’t pay your bills. So long as your line manager is happy with how you are getting on, everything else should fall into place. A lesson I’ve learnt is that, as the Queen apparently once told Edward Heath, none of us are indispensible. All we can do is try and keep the people who matter at work happy so that we are free to get on with our work without too much interference. That is one of the best ways to keep work stress manageable.  And it makes it easier to leave it behind when you clock off.

The Swiss Roll Days– coming back from the bad times

You, dear reader, are no doubt a person of high taste and class. You have probably never eaten an entire supermarket, chocolate, Swiss roll by yourself in one sitting. So why not take four minutes and 43 seconds to listen to Damien Rice’s song Volcano, and find out why I associate both it and consuming huge quantities of this cheap sugary stodge with really hard time in my life.

It was 2005, and I was living alone in a beautiful, rented, flat in a part of London I didn’t know well. I was in the very fortunate position of – just – being able to get onto the property ladder, and I had moved to the area to see if I wanted to live there.

In hindsight, I was so desperate to be ‘doing the right thing’ that I let my head override my heart, which was telling me that I needed to be closer to town with less space, then live further out with more.

It takes a certain kind of 29-year old to be demented enough to think that they have to have made all their big life choices by the time they turn 30. I was that kind of person.

It felt like my friends were all growing up and settling down, and I was left behind. Lots of things came to a head, including the messy break-up of an ill-advised relationship, and I ended up having to take a month’s sick leave from work that year. The highs of manic depression are well documented elsewhere, so you can look elsewhere on the Internet for descriptions of what that’s like. What goes up must come down, and the low period was particularly grim. I spent a lot of time alone, off sick, watching daytime TV and eating Swiss roll. I could eat an entire family-sized cake to myself, stuffing it in without tasting it much. I believe there is good evidence that carbohydrates and stodgy food trigger serotonin production. That might explain why we rarely crave carrot sticks and hummus in a crisis.

I mention all of this because after my last post, I read some great blogs from purplepersuasion and others about how just grim it is to have to deal with bi-polar disorder. So I just wanted to make it clear that I don’t consider myself ‘cured’. ‘Healed’, yes, in the sense that I feel there is a good chance I might not get ill again, but I don’t take my good mental health for granted.

I know all too well how tough it is to recover from an episode. The only thing I can compare it to is learning to walk again after a serious car crash, but no-one can see just how battered you’ve been by the illness. They might say monumentally unhelpful things like ‘pull yourself together’, or question if you ‘really are ill’ or just attention-seeking. As purplepersuasion puts it so well here, of course I’m seeking attention! How else do we get help?

The only way forward is to take painstakingly slow small steps with good support and lot of patience. It’s a case of moving from spending all day indoors, to making it outside, if only for a hour, and then gradually on to re-entering the ‘normal’ world.

I spent a lot of time indoors during that month in 2005, quite a lot of it listening to the CD I got free with an issue of Glamour magazine two years before that. This Damien Rice song was on it, and it’s a very up and down, melancholy tune about not damaging yourself. Funny how that struck a chord, isn’t it?! It’s a beautiful, haunting tune – listen to how the ‘cello soars and dips, shimmers and supports the singers. There is, admittedly, a disturbing line about a girl ‘still being too young’, but I choose to ignore what that could mean.

So how do you get through the tough times? Whether you have bi-polar yourself, know someone who has or just have an interest in mental health, what works for you? Hopefully something healthier than Swiss roll!

Underground, overground: we all need friends

I never was cool at school. At least, that’s how I remember it: cool enough not to be a social outcast but never quite part of the in-crowd. I was too serious and intense. I preferred to float from group to group, not wanting to be labelled.

Rodin's thinker

Too much of this is Not Good for your school street cred!

In hindsight my tomboyish nature meant I paid very little attention to my appearance until I was relatively old. So I was never a girly, or particularly glamorous, teenager until I grew into myself a little. There was definitely nothing rock-and-roll-cool about playing the piano and violin back then, which I did, reluctantly and under duress.

That’s partly why I really like this Ben Folds Five song, Underground. There’s a huge amount of geeky energy going into creating a pounding piano sound that gives the impression the band are much bigger than they are. There’s only one guitar and mainly a heartfelt plea for accepting someone being an outsider and welcoming you to a world underground where everything is better. It’s also a very upbeat, swaggering song that perhaps has echoes of the energy and buzz of hypomania. And you’ve got to love young men who are all wearing the same fetching orange T-shirt in this video. Ah, 90s fashion!

When I was unwell once, I took to ringing up my friends and family and playing this song down the phone to them. Perhaps I felt underground and lost. A therapist would say there was some deep meaning to it. I thought it was funny and I was making a point, somehow, but I didn’t really know what it was. For my nearest and dearest, it was most likely irritating, annoying or a worrying suggestion of more serious illness to come.

Ask anyone with an ounce of common sense or experience of mental illness, and they will tell you that having supportive family and friends is vital to recovering (a fancy way of saying getting better). But the trouble is that being around someone who is experiencing the symptoms of mental illness can be very distressing. For some people, it’s plain baffling and very hard to accept they are dealing with symptoms which can be treated, not a ‘mad person’ who won’t ever get better.

I’ve been blessed with a very supportive family and friends. My immediate family once came with me to a Manic Depression Fellowship conference about living with bi-polar disorder. My sister emerged from one workshop looking baffled and quietly stunned. There had been a whole room of ‘people like me’. My illness wasn’t, apparently, just down to me behaving strangely and seeking attention. Her face and manner pretty much said: Huh! Who knew? I thought it was just you, being weird!

Over the years I’ve found it can help to try not to lean too much on the same people when I’ve been unwell, or just plain stressed and struggling to cope with life. I don’t know if they’ve noticed, but I hope it’s helped my closest family and friends eke out their goodwill a bit longer.

Of course, caring for someone who is ill is something we should all do for the people we love, regardless of the symptoms. No-one should feel guilty for having a mental illness, or be afraid of asking for help. It’s just an unavoidable aspect of mental illness that it can put a lot of pressure on relationships.

I’ve found therapy helps – and also having different people in my life for different kinds of support. These include former colleagues who also have experienced mental distress and can provide work and career advice. Equally, it’s good to have people who you don’t talk to you about your illness so that it doesn’t define you. If you get ill and lose your sense of self, it’s hard to truly recover if you enter into a kind of ‘mental health ghetto’ in which your main contacts are with health and social care professionals and not with the ‘normal world’ of work and social activity.

Also, advance directives can be a very useful way of giving people instructions about what treatment you’d like if you are unwell. It takes the subjectivity and sting out of supporting someone who may well be saying and doing things that are pushing just the buttons that wind you up and make it hard to care for them. Advance directives can be adapted for work or at home, and help give you, the person with a mental illness, some control over what will happen when you can’t say what you need. This link will take you to a pdf produced by Rethink, all about advance directives.

I’m incredibly grateful for all those people who have stood by me, even when that’s been upsetting and difficult. Or just plain exhausting. It’s hard and challenging and upsetting for carers, as well as the person who is actually ill. I’ve recently found myself part of a team at work, all of us who have a mental health issue of one kind or another. It’s the first time I’ve been in relatively good mental health, compared to a colleague who has had severe anxiety and been through a very difficult time. For the first time, I’ve been the relatively ‘normal’ one! It’s helped me realise just how exhausting it can be for the people around you when anxiety takes hold, and how easy it is to lose sight of the person behind the symptoms.

Hopefully in time the stigma will lift and make it socially unacceptable to turn your back on friends and family who are unwell. At my most ill, it would have been hard to imagine my life would be as good as it is now. We don’t hear enough about how this kind of recovery is possible. Too many of us lose friends and loved ones who just don’t know how to cope, are too afraid to ask for help or know that, like the fantastic Stonewall campaign slogan, it gets better.

Yes: McAlmont and Butler


David McAlmontDavid McAlmont

Happy 20th anniversary, Britpop. We’ve been marking your anniversary all over the BBC this week. I had a flashback to the mid 1990s of a different kind recently. I went back to Bart’s Hospital for the first time, quite possibly, in 20 years.

Walking past a gaggle of excited young Japanese girls paying homage to Benedict Cumberbatch’s fake death at the shrine to ‘Sherlock’, I found myself back in the same building where I was once a psychiatric inpatient. At least this time I was an outpatient with a minor ailment, returning to work as soon as I was done, not stuck inside an overheated set of rooms thick with staleness and sweat.

There’s something about the smell of a hospital that is always sickly, even if you aren’t. That thick, warm, cloying air took me right back to the days when I could check in but only leave if a doctor deemed me well enough.

The smooth, electric doors were still the same; opening onto the square outside with an even, low hum. The wide, grand stairs hadn’t changed, even if the wards all had. The psych ward appeared to be long gone, though there was a plaque on the wall to mark that the Queen had opened it in the early 1990s, not long before I was first admitted.

Anthropologists have a nifty term to describe a process that changes you in such a way that you are never the way you once were. I which I could remember what it is, but it applies if, say, you were once married and are now divorced. You can never go back to being the same single person you once were before you met your spouse.

Being admitted to a psychiatric hospital is much like that. While my friends were off on gap years being au pairs in Germany, I was being treated on an adult ward surrounded by some seriously ill people. Like the guy with a thick black beard that obscured much of his face, and who was fond of eating cigarette butts. No wonder my former teachers refused to tell my classmates quite what was going on.

Once out of hospital, though; that’s when the hard work begins. How do you figure out who you are, when your mind cannot be trusted? How to rebuild your life, when it’s been shattered in tiny pieces?

It’s a slow, gradual process of rebuilding and regaining confidence. Of accepting that you have an illness but you have not lost your mind forever. That because there are people who have gone before you and done the same, so you can follow in their path. Admittedly for me, that was, essentially, Spike Milligan or Kay Redfield Jamison. Great and talented people, but not part of my world, really. This was long before the days when ‘bipolar’ was a synonym for edgy creativity or the amazing talents of Stephen Fry.

I noticed that some folk treated me differently. They didn’t quite know how to react. Of course, now, I can see that many people were just kind and concerned. Then, though, I felt very prickly. I didn’t want to be reminded of just how ill I had been. I needed to move on, and it felt like some people were just waiting for some kind of sign of relapse because they found it hard to believe I could get better.

Look! There she goes again with the crazy ideas! Maybe she’s gone mad again! (Or maybe I was just being my creative self. It was very hard to tell at first.)

One manifestation of this fear was the Sympathetic Head Tilt. When people would subconsciously lean their head to one side and ask, “how are you?” They may have meant to convey sympathy. What I heard was: “are you going crackers again, or are you ok?” Sometimes, I wasn’t sure, but the tone of the questions didn’t really help much. It made it hard to say I wasn’t ok, just yet, but I was getting there.

Over time, I did get better enough to go back to school, take my A-levels and make it to university. One song that I associate with this time of recovery is ‘Yes’, by McAlmont and Butler, which came out in 1995, the year after my breakdown. It’s a gloriously over-the-top, bitter, pop confection about telling people to take their sympathy and shove it someplace painful. At least, that’s what I hear. David McAlmont’s voice may be falsetto but he packs a powerful punch. The soaring strings give the song a gloriously uplifting quality.

Though I can’t claim to have been a massive Suede fan, Bernard Butler wrote it, so you know the song is crafted by an expert. I now know he wrote Yes as a particular kind of break-up song, but I hear it as a sock in the eye to people who find it hard to believe that people can and do recover from mental illness. Back in the mid 90s, there seemed to be a lot of them around. Care in the community was something of a joke, even then.

So that’s why when I hear David McAlmont sing “Yes, I do feel better/I feel well enough/To tell you what you can do/With what you’ve got to offer”, I remember that feeling of youthful defiance, sticking up two fingers up to the world and not letting it grind me down. If only for a few glorious moments of deceptively frothy pop.