5 years ago ·

Understanding: OCD

Obsessive Compulsive Disorder, or OCD, is one of those mental illnesses that everyone has heard of. This is partly because society tends to use the term as shorthand for someone who is quite clean, or who likes things to be organised, or who is very particular about how they fold their t-shirts. The phrase ‘I’m a bit OCD’ has become so commonly used that most people probably think that they have a good idea of what it’s like to suffer from OCD, but the reality is very, very different, and often much more difficult to live with, than just enjoying a neat and tidy kitchen. In fact, individuals with OCD and organisations that represent them have asked that the term not be used so casually to describe general preferences that most people experience.

In this blog we’re going to talk about what OCD actually is, how it manifests in different people, and what treatment options are available.

What is OCD?

Well, as the name suggests, OCD is made up of two different kinds of symptoms; Obsessions and Compulsions.

Obsessions are defined as intrusive or unwelcome thoughts, feelings, anxieties or images that appear in the mind seemingly without cause. Lots of people will experience this kind of thing, if you’ve ever felt anxious or nervous then you almost certainly know what it feels like to get stuck on a particular thought that you can’t seem to shift, or to have negative feelings appear in your mind suddenly. Sometimes these obsessions are called Intrusive Thoughts. The vast majority of people have experienced intrusive thoughts to some degree, if you’ve ever been in your car and have had a sudden urge to steer into oncoming traffic then you’ve had an intrusive thought, and usually they’re totally manageable and easy to ignore. What sets OCD aside from this kind of every day experience is their intensity, but also that they appear alongside Compulsions. Compulsions are defined as repetitive or ritualistic actions that are taken in an attempt to reduce or manage the anxiety associated with these obsessions.

Obsessive cleaning is one of the more common symptoms of OCD.

You’re probably aware of concept of compulsions. Whenever OCD is portrayed in the media, compulsions are generally expressed in one of two ways; hand-washing or flicking light switches. It’s true that these are common compulsions for people with OCD, but they are far from the only compulsions. Generally, compulsions fall into one of the following categories:

  • Washers are afraid of contamination, and will wash or clean themselves or their surroundings compulsively.
  • Checkers repeatedly check and confirm things, such as locks or ovens, to confirm that they are safe.
  • Doubters and sinners are afraid that if everything isn’t perfect and completed in specific ways then bad things will happen.
  • Counters and arrangers will attempt to organise and arrange things in their lives and often display obsessive behaviour or superstitions relating to coordination, counting, numbers and structure.
  • Hoarders fear that something bad will happen if they throw anything away, and will often collect large quantities of items or belongings.

As you can see, some of these types of compulsion have a kind of logic behind them. We can understand the anxiety associated with feeling dirty or messy, and we can see why someone would check locks and appliances. Others, such as counting or obsessively organising objects, are more superstitious in nature, and may be trickier to comprehend if you don’t suffer from OCD yourself. It’s important to understand that compulsions are real to sufferers of OCD, and that just because they don’t make sense to us doesn’t mean that they can be dismissed or ignored.

Completing compulsive behaviour usually doesn’t lead to any pleasure, but may reduce anxiety temporarily, providing some brief relief from the obsessive thoughts. This can lead to a vicious cycle, whereby obsessive thoughts lead to anxiety which leads to compulsive behaviour, which then results in temporary relief followed by further obsessive thoughts.

What is the impact of OCD?

Usually there wouldn’t be a need to include this section. Most people can inherently understand the harm caused by anxiety or depressive thoughts or hallucinations, those things are obvious. But it can be harder to truly understand the experience of someone with OCD and all the myriad of ways that it can impact on their life. Take a second to consider how long it would take to check and double check the light switches, doors and windows in each room in your house before you could leave, and what changes you would need to make to your life in order to accommodate this behaviour. It can be easy to see how the condition can end up dominating every aspect of your life, and how the obsessions can end up spiralling out of control.

Checking locks is a way of controlling the physical environment.

And control is a very important aspect of OCD. Scroll back up and look again at the categories of compulsions from earlier on. What do they all have in common? They all relate to attempts to impose control over things in our lives that are chaotic, unmanageable, unknowable or outside our sphere of influence. They all relate to a sense that if we do not complete these very specific actions, or take measures to reduce risk, that bad things will happen to us or people that we love. We all understand this to some degree, we’ve all sat at home at night on our own and heard a noise and been freaked out, and maybe we’ve then gone and checked all the doors and windows even though we know that they’re all closed and locked. We’ve all got halfway to the car before suddenly wondering whether we remembered to turn the oven off, even though we’re sure that we did, and had to go back to double check so that we can relax. Our brains are wired in such a way that we tend to assume the worst so that we can plan effectively, and we instinctively attempt to impose order and control over things in our lives. Well, people with OCD experience these very same feelings, they just experience them more often and at a much greater intensity, often to the point that they may struggle to function, and may become overwhelmed with their compulsions.

If you have time, this is a really interesting documentary about individuals living with OCD:

How is OCD treated?

If you’ve read any of my other blogs about specific mental illnesses, this will be a familiar section to you, because OCD is treated in a very similar manner to other mental health conditions; with a combination of medication and psychological therapy.

The primarily kind of medication used to treat OCD is the same kind of medication used to treat most kinds of depression and anxiety; Selective Serotonin Reuptake Inhibitors, or SSRIs. This kind of medication treats OCD by reducing general levels of anxiety, and therefore reducing the obsessive thoughts that drive the compulsive behaviour. For relatively mild cases of OCD, this may be all that is needed, but in more serious cases a course of psychological therapy may be required. This therapy is usually Cognitive Behavioural Therapy, and is particularly effective at treating OCD as it teaches sufferers practical techniques that can be used to manage the intrusive, obsessional thoughts. This will generally include mental exercises, tactics for reducing anxiety and verbal prompts and reminders that help to move the mind away from the cyclical thinking that can lead to compulsive behaviour. These methods are built around the concept that the mind is a muscle that needs to be exercised and trained, and that with discipline and repetition we can build new connections so that anxiety doesn’t automatically lead to compulsive behaviour. This can include carefully encouraging sufferers to engage with their anxieties and take action that makes them feel uncomfortable, or acknowledge anxiety caused by inaction, in a controlled setting without seeking relief via compulsive behaviour. It isn’t a quick process, and can be very stressful and difficult for people seeking treatment, but success rates are good.

It’s very important to remember that simply refusing to indulge OCD symptoms, or dismissing them as silly or pointless, will not work, and can even make things worse. Some people believe that if someone with OCD would just stop washing their hands or checking the windows that this would prove that everything is fine and would ‘cure’ the compulsive behaviour. OCD treatment is not that simple, and any attempts to encourage individuals to engage with their anxieties or face their fears should only be made in controlled environments by professionals. This kind of therapy is generally known as Exposure Therapy, and may be used in place or, or in conjunction with, CBT.

Exposure therapy works by encouraging the individual to confront situations or objects that cause anxiety without relying on ritualistic behaviour. Typically this is done in a slow, controlled manner, starting with small amounts of exposure for short periods of time which is tolerated for as long as possible, and moving on to longer and more intense exposure once this is manageable. For example, someone who has rituals related to cleaning may be encouraged to touch or handle dirty objects for short periods of time. In the past this form of therapy was done in a much faster and more sudden manner, typically by introducing the individual to high levels of stress and anxiety quickly in the hope that this may have a similar effect to pulling a plaster off quickly. Nowadays this is not generally advised, as it can cause levels of stress that are difficult to tolerate. 

A good way to think about exposure therapy is to think about getting into a cold swimming pool. Getting into the pool slowly, bit by bit, and waiting for your body to acclimatise to the new temperature is a lot less shocking and uncomfortable than jumping in quickly. It takes something that could be very stressful and upsetting and makes it manageable by doing it slowly in a controlled manner, and as we know maintaining control is often very important for people with OCD. 

Exposure therapy is complicated and requires professional guidance and should never be attempted without proper training and supervision, as if done incorrectly it can actually make the symptoms worse. 

If you or anyone you know is suffering from OCD, or you are worried that you are developing symptoms, you should always contact a GP. OCD rarely gets better on it’s own, so you should always seek help if you are concerned. If you need immediate help, or are worried that you may harm yourself or someone else, you should call 999 immediately.

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5 years ago ·

What Arch Care Services has given me.

The following was submitted by one of our service users, who has asked to remain anonymous.

I’ve been asked to write a little something for the Arch Care website, something that I am very happy to do since they have given me my life back.

Since my adulthood I’ve had to deal with the condition of bi-polar, formerly known as manic depression, something which has wrecked large parts of my life throughout my 20s.

Though having obtained an English Lit degree from the University of Aberstywyth when I came out of it to return back to life in Weston with my parents I struggled to cope.

Before I went off to Uni I had won first prize for a one-act drama I had written in an arts competition held at the Blakehay Theatre, something that I did more of when I was at Aber and was particularly successful at.  But when I returned to their actors company I was told that they had lost their funding due to arts cuts and in thinking of trying to further my writing I was struggling to know were to turn.

Things broke down between me and my parents and I was put into accommodation with a housing company called Curo, which I didn’t like much as I felt very isolated.

I spent years with Curo until I was evicted by them and spent a terrible couple of months in hospitals and temporary accommodation in Bristol.  But when I went back to hospital some people from Arch Care said they could take me on in their new place in Clevedon.

When I visited the place I couldn’t believe it.  An actual house!  With a garden!  And no CCTV!  I moved in and soon got a book case, a telly, a typewriter and a comfortable chair from the Changing Lives charity shop across the road and soon I was settling in with the place and living with the others people in the house in a way I couldn’t have done before.  I was really happy that everything had worked out.

Things kept on working out, soon after I moved in I was offered a involvee job at the hospital to facilitate creative writing, I self-published a long poem called The First Man In Space, which I’ve sold a few copies of, sent off a play to a London theatre, done a short teacher training course, been volunteering with the Theatre Shop and seeing lots of plays, read twenty books, and now I’ve been offered another job at an art gallery running a course on how to write about art.

This success has been largely due to the comfortable space I’ve been offered as well as the help and support I’ve been given by the live-in staff.  It’s been transformational.  And I’ve stayed well.  It’s an understatement to say that this has been one of the best years of my whole adult life and I’ve partly Archcare to thanks for it.

Now I am about to view a place in Weston and I now have the confidence to tackle living on my own and continue my writing career to take me into more and more interesting places in the future.  I feel I have a better handle on my illness thanks to mood diaries and mindfulness as well as medication and feeling more stable within myself.

What a result!

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5 years ago ·

Understanding: Postnatal Depression

Having a baby is the most incredible, magical, awe-inspiring thing that we will ever do. The first time you see your child it’s like your heart grows ten sizes and you’ll feel nothing but love and happiness. Or so we’re told! In reality, having a baby is a wonderful experience, but it’s also exhausting, stressful, confusing, complicated and frightening. It’s the biggest responsibility that you’ll ever take on, and it’s also one that you’re never going to be prepared for, AND you have to do it all while you’re more sleep deprived than you’ve ever been in your life! Yet we’re still not great at acknowledging that some people struggle with the process, and that for a lot of people it isn’t the amazing Hollywood experience that they have been taught to expect. Most of the images we have in our head when we think of having children are like this:

or this:

But I think we all know that in reality there’s also a lot of this:

and this:

Having just come back to work from paternity leave myself, this topic has been on my mind a lot, so this week we’re going to be thinking about postnatal depression, how it affects new parents, how it can manifest, and what we can do to help.

What is Postnatal Depression?

Postnatal depression is a form of mental illness that affects new parents, particularly women. Around 10% of new parents will experience some form of postnatal depression, so it’s a very common illness. It’s very different to the ‘baby blues’, which is a period of around a week after birth where women are likely to feel teary, overwhelmed and emotional. This is totally normal and most women will experience it. It only starts to become a concern and something that needs extra attention if those symptoms last longer, start later, or are of increased intensity.

Some of the most common symptoms of postnatal depression are:

  • A persistent feeling of sadness and low mood.
  • Lack of enjoyment and loss of interest in the wider world.
  • Lack of energy and feeling tired all the time.
  • Trouble sleeping at night and feeling sleepy during the day.
  • Withdrawing from contact with other people.
  • Problems concentrating and making decisions.
  • Difficulty bonding with your baby.
  • Frightening thoughts – for example, about hurting your baby.

Can you spot one reason why postnatal depression can be difficult to identify and diagnose? If you look at any new parents you’re likely to find that they’re tired, withdrawn, find it difficult to concentrate and lack energy. A lot of the symptoms of sleep deprivation, along with the emotional stress of taking on such a huge new responsibility, are going to be very similar to the symptoms of depression, and so the illness can be masked or hidden. Also consider how difficult it would be for a new parent to admit to a medical professional that they’re having violent thoughts about their own child, and it starts to become clear that a lot of people with postnatal depression fail to seek help. Society has to take some responsibility for this. We have created and maintained unrealistic expectations of parenthood, and admitting that you’re struggling or that you’re not 100% happy all of the time can be a very shameful experience, particularly for women. Yet we also know that having a baby is one of the most difficult times of our lives! No wonder it’s so confusing!

It’s also possible for new parents (again, usually women) to develop a condition called postpartum psychosis. This condition is a lot less common, but has much more serious symptoms and needs to be taken very seriously. Some of the more common symptoms of postpartum psychosis include:

  • Hallucinations.
  • Delusions – thoughts or beliefs that are unlikely to be true.
  • A manic mood – talking and thinking too much or too quickly, feeling “high” or “on top of the world”.
  • A low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping.
  • Loss of inhibitions .
  • Feeling suspicious or fearful.
  • Restlessness.
  • Confusion.
  • Behaving in a way that’s out of character.

Postpartum psychosis can lead to situations where the person is no longer aware that they may be unwell, or may be suspicious or reluctant to seek help. That’s why it’s so important for partners, friends and family members to be aware of the symptoms and be ready to act if they have any concerns. Click here for more information about postpartum psychosis.

What causes Postnatal Depression?

We don’t really know for sure, but it seems likely that it’s exactly the kind of things that you would expect. It appears that a history or family history of mental illness, social isolation, a poor relationship with a partner or other stressful life events can all act as triggers and bring on postnatal depression, but even without any of these other factors having a baby is a huge, life changing event, and this is exactly the kind of thing that we would expect to be a cause of depression in general.

One thing that we’re fairly sure of is that there isn’t much that anyone can do to avoid it. There are some general lifestyle decisions that will help to maintain good mental health in general, such as the suggestions found in one of our previous blogs, and you should always speak to your GP if you have a history of mental illness and are expecting, but all the available evidence suggests that it’s largely outside of our control. Despite this, many people struggle with a lot of guilt and shame when they are diagnosed, and some feel like they have failed as parents. Nothing could be further from the truth! All it means is that we are all human, and we all need some help and support sometimes.

How is Postnatal Depression treated?

Postnatal depression can be a very lonely and distressing illness, and as we’ve said, it can carry with it a lot of shame and guilt. But there are treatment options, and as long as you seek help then it’s a completely fixable condition.

Possible treatment options can include:

Self-help – Opening up to friends and family and talking about your concerns, leaning on those close to you and asking for practical help when needed, trying to get sleep whenever possible, and taking time to do things that you enjoy can all be beneficial. Remember, these things will not always be effective on their own, so if you need additional support then that’s nothing to be ashamed of.

Psychological therapy – As with most other mental illnesses that we’ve spoken about, the most common kind of therapy is Cognitive Behavioural Therapy, otherwise known as CBT. This is generally prescribed by a GP.

Medication – Medication will usually only be used if the other kinds of treatment have not been effective. Don’t worry about breastfeeding, anything you are prescribed will be safe.

Local and national organisations, such as the Association for Post Natal Illness (APNI), and Pre and Postnatal Depression Advice and Support (PANDAS), can also be useful sources of help and support.

If you know someone that has had a baby recently you should make an extra effort to help out wherever you can. Don’t just go round and coo over the baby and leave, take round a home cooked meal, give the kitchen a quick clean or offer to watch the baby so they can have a nap. Keep an eye on each other, and if you have any concerns then ask if they’re ok or if they want to talk. And most importantly, never shame a new parent for expressing concerns!

Remember, postnatal depression is absolutely normal and natural, and if you do struggle then there is nothing to be ashamed of! It’s ok to find parenting hard and to need some help, it’s alright to not feel happy 100% of the time, it’s ok to be angry and tired and sad and frustrated and overwhelmed and exhausted, and it’s ok to admit that you’re not a perfect parent immediately. With the right help and support you will be absolutely fine and can enjoy all the amazing things about having a new baby.

If you are a new parent and have any concerns about your mental health you should contact your GP. If you think that you are at immediate risk, or feel like you may harm yourself or someone else, you should always call 999 immediately.

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6 years ago ·

How should we talk about mental health?

By Andy – Arch Care Services

It can be very confusing, knowing what we should and shouldn’t say. Certain words that we use all the time can accidentally end up offending someone, or may be old fashioned or out of date, and it can be difficult to keep track. People who suffer from a mental illness or people like me who work in the industry use these terms all the time, and it can sometimes be difficult for us to remember that not everyone knows the right thing to say, or what words they should avoid. Well, today I’m going to give you some advice about how to talk about mental illness without accidentally putting your foot in your mouth!

Let’s start by considering the most important thing of all; how do we describe a mental illness in the first place? There are lots of words that used to be used all the time but that we would advise everyone to avoid, as they sound quite old-fashioned and out of date, and in some cases are actually quite offensive! The one that we hear most often is that someone suffers with ‘mental problems’.

I can only assume that it comes from all the American media that we consume, because in America ‘mental problems’ is a fairly common phrase. We tend to avoid the use of words like ‘problem’ when it comes to describing a mental illness for the same reasons that we wouldn’t describe someone with diabetes as having a glucose problem, or someone with asthma as having a windpipe problem; it’s a little simplistic and vague. It also suggests that people who are mentally unwell have a ‘problem’ of some description, which is the kind of thing that we try to avoid. We also hear the term ‘mental disability’ quite regularly, which makes sense but is quite old fashioned. It also suggests that someone with a mental illness has reduced abilities of some kind, which isn’t always the case. Not the most offensive thing in the world, but not very accurate and probably best avoided.

It goes without saying that you should completely avoid terms like crazy, schizo or insane. They are very offensive and unpleasant and are used as a way to make fun of people. No one in the industry would ever use those words to describe the people that we support, and you shouldn’t either.

So, what is the correct thing to say? Well, you may have noticed that I’ve been using it all the way through this blog. We would always say that someone has a mental illness, they are mentally unwell, or they struggle with their mental health. Some people use the term psychological health instead of mental health, and that’s fine as well. These terms are used because they incorporate a number of different conditions and diagnosis’ and don’t lump everyone in together, and they also highlight the fact that it is an illness, and therefore something that is out of our control, can happen to anyone, and can be treated. This might change at some point in the future, but for now this is the best thing to say.

Now lets consider some things that you might say casually and innocently that are actually quite offensive to some people, and should probably be avoided if possible.

Enjoying having a clean house doesn’t mean that you have OCD!

Have you ever described yourself or someone you know as being ‘a bit OCD’? Maybe they’re quite a clean person, or they like things to be organised. Maybe they like to use a specific font when they type up a documents, or they alphabetise their DVD collection. I imagine that most of you have, I imagine that I’ve done the same thing at some point, but I make a deliberate effort to avoid using this term incorrectly, as Obsessive Compulsive Disorder is actually a very serious condition, and one which can have a massive impact on the lives of those that suffer from it. The symptoms of OCD can ruin lives, and are far more than just wanting things to be neat and tidy or not liking it when things aren’t organised properly. And how about bi-polar? Have you ever heard someone describe themselves as being bi-polar because they have mood swings, or because sometimes they feel annoyed for no identifiable reason? As with OCD, bi-polar disorder is a serious illness that can have serious symptoms, and is far more than just feeling like your mood is changeable. Organisations and individuals with these conditions have asked that these terms not be used casually as they may minimise the experiences of suffers, and we should do all we can to respect this. This isn’t to say that we should belittle experiences or assume that people are exaggerating when they use these terms, we should just try to be mindful about when we say them and whether they are really appropriate descriptions.

It’s also vital that we understand the difference between a mental illness and a learning disability. Sometimes people use the two terms as if they mean the same thing, or are parts of the same category of condition, and this couldn’t be further from the truth. Anybody can develop a mental illness at any time in their life, and it may be treated and then go away, whereas people will have a learning disability from birth, and it cannot be cured. The symptoms, behaviours and experiences of people who suffer from a mental illness are very, very different to those who have a learning disability, and confusing the two is quite offensive to some. It’s a bit like confusing asthma with blindness, the two are not comparable and it would be strange to suggest that they are.

Some of you may remember this encounter from the news:

As you can see, the woman approached Theresa May to ask what steps she planned to take to support people with learning disabilities, and in her response the Prime Minister made reference to planned changes to mental health provision. She was criticised following this incident specifically because she seemed to fail to understand the difference. Maybe this was nothing more than a slip of the tongue, but it feeds into a common misconception and is quite damaging to public perception when the Prime Minister is making such an easy mistake.

I know that this can sound complicated or difficult to understand. You may even be wondering what the big deal is, they are just words after all! Well, the words that we choose have power, and if not chosen and used carefully they can be hurtful, rude or thoughtless, even if that isn’t our intention. A small amount of effort can make a big difference, and can contribute towards tackling the stigma that people with mental illnesses face on a day to day basis.

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6 years ago ·

Living with Anxiety

The following blog was submitted by a member of staff at Arch Care Services. They have asked that they remain anonymous.

I had a very normal upbringing with loving, supportive parents, but everyone always described me as an anxious child. I remember distinctly worrying about the end of the world when I was 4 or 5 years old, and I developed a form of social anxiety at a relatively young age which manifested as a profound fear of looking stupid or annoying people. I didn’t really know what it was at the time, I just remember monitoring my words and actions closely and being hyper aware of how other people responded to me. In fact, one of my earliest memories of childhood was being driven home from school by a friend of my Mum. She was having a conversation with a friend in the front seat while I sat in the back and I attempted to join in, which made them laugh. Looking back I can see that it wasn’t malicious, they were finding humour in a child making an adult-like comment, but that stayed with me, and I felt nervous about making comments in adult conversations from that point onwards. That should tell you what kind of child I was!

School was always a challenge for me.

This continued throughout my childhood, and my overriding memories of school are of feeling anxious, uncomfortable in my own skin and intimidated by kids my own age and how easily and smoothly they seemed to socialise and make friends. I wasn’t miserable by any means, I was generally quite positive and cheerful in most aspects of my life, I had friends and was doing fairly well academically, there was always just this nagging sense that I didn’t quite fit in, which led to a couple of years of over-compensating, acting up and behaving badly in an attempt to make friends. I thought that if I could be loud and funny and disruptive then this would cover up my insecurity, but really it just made me feel worse. Knowing what I know now about mental illnesses, I can see that I was suffering from an anxiety disorder, but I didn’t have the language or the experience at the time to identify exactly what it was that I was feeling, I just kind of assumed that everyone felt that way.

I spent a lot of time alone in my first year of university.

When I reached university at age 20 my mental health really started to decline. I suddenly found myself in a huge city for the first time, surrounded by new people who all seemed so much older and more comfortable than I was. For someone with some hang-ups around fitting in and making friends this was a terrifying situation, I was overwhelmed by the constant need to be social and present this image of myself that was polar opposite to the way that I was feeling. The pressures of the course and my studies were fine, I could handle that, but having to constantly present myself in the way that I wanted to be seen by my peers, living in the same building as a collection of loud, drunk strangers, having no retreat where I could go to hide and recharge at the end of the day, that was a struggle. And to make things worse, I suffered from an unexpected bereavement at around the same time, which only exacerbated my blossoming mental illness. I started to find it difficult to spend time with people, which led to me finding it difficult to go outside, which eventually led to me finding it difficult to leave my room at all. My laptop and my DVD’s and my bed all became my comfort blankets and my safe space, which I became reliant on in unhealthy ways.

It all reached a tipping point one day around exam time. When I was anxious I found revision comforting because it allowed me to lose myself in a world of logic and facts for a few hours, which blocked out some of the cyclical negative thinking that had become my normality. I also used to gravitate towards a nocturnal lifestyle, staying up later and later each day and sleeping for longer and longer, or managing on very little sleep when I had lectures to go to, all so that I didn’t have to interact with people. During exams these two factors coalesced into manic revision sessions, hours spent hunched over a textbook in my poorly lit room in the halls of residence scribbling notes and drawing mind-maps, downing cups of black coffee until my hands shook and I felt sick. On this particular night I had been writing for what felt like a couple of hours and decided to take a short break, but when I looked at my clock I found that I had been scrawling notes in my exercise book for 9 hours without stopping. The sun was starting to rise outside, and I hadn’t even noticed that it was night time. I went into the bathroom to splash cold water on my face and caught sight of myself in the mirror, and for a terrifying moment I didn’t recognise the reflection staring back at me. I had gained weight, my face was grey and drawn and I had been wearing the same clothes for two days. Which also meant that I hadn’t been outside or spoken to anyone in two days. Before this I had always taken a lot of care of my appearance, and I was shocked at how terrible I looked, and how far I had allowed things to decline.

I found it difficult to make friends and fit in.

I skipped my lectures that day and went for a long walk along a river near to my student accommodation. For the first time I stopped and examined my thoughts and my behaviours and started to understand that this wasn’t normal, that I wasn’t doing alright. Up until that point I had never really considered that there might be something bad happening to my mind, I just assumed that this was what life felt like, but as I watched the other students walking to lectures, looking fresh and well rested and chatting happily to their friends, I realised that this wasn’t the case. They were carefree, relaxed and happy. It didn’t look like they were struggling to speak to each other. They were wearing clean clothes and smiling, and I couldn’t remember the last time that I had felt how they looked. I went home and showered and changed my clothes, and then I booked a doctor’s appointment. When they asked what the appointment was for, I told them that I thought that I might be depressed.

I actually ended up being diagnosed with an anxiety disorder, and was given a prescription for Citalopram, one of the most common kinds of SSRI based anti-depressant. It was a relatively low dose, but I was told to take it daily and to come back in six months. I had the usual reservations about medication, and was worried that it would lead to personality changes or would make me dull or zoned out, but once I had been taking them for a few weeks I started to notice the changes. I didn’t feel any different in ways that I could easily identify, but I wasn’t worrying as much. Spending time with people was still tiring, but it wasn’t an anxiety minefield in the way that it once was. I could go shopping again without having to spend hours working myself up and mentally preparing. I would deliberately test myself by sitting and thinking about all the things that used to make me feel nervous and twitchy, but they didn’t have the same impact, it was like the part of my brain that had caused me to overthink and obsess and worry had been switched off. The knock-on affect of this change was significant. My sleeping improved, I started eating better and spending more time outside. I made friends and chose to leave my room because I wanted to, rather than because I felt like I should. It felt like a grey fog had been lifted from my eyes and everything suddenly seemed clearer and brighter, and I had the sudden realisation that this is what life is supposed to feel like, this is how other people experience the world!

Things aren’t always perfect, but i’m happier than I’ve ever been.

A lot of people have some negative impressions of anti-depressant medication, but they gave me my life back, and gave me the mental freedom that I needed to identify problems and make changes in an effective way and with a clear head, changes that would have been impossible a few months prior. When I decided to stop taking the medication around a year later (with help from my doctor, you should never stop taking medication suddenly and without seeking medical advice), I found that the feeling persisted, because I had made changes to my life and thought patterns that stayed with me.

That was a long time ago now. I’m older and wiser and have a career and a family and that dark patch seems like it was a lifetime age. Don’t get me wrong, I still have bouts of anxiety, I still struggle with social situations sometimes, and I’m still prone to obsessive, circular thinking when things get stressful. Once I even had to take some time off work and go back onto the medication for a while. But nowadays I can understand my anxiety, and generally we’ve found a way to co-exist peacefully. I think that I’ll always suffer with it in one form or another, and part of me thinks that it has taught me some really important lessons about myself and given me insight that I wouldn’t have without it. I’m now confident that I have it under control; I know my triggers, I know when I start to feel low and the steps I can take to manage it, and I’m conscious of when I need to practise some self-care. Anxiety may be a part of who I am, but it’s not the main part.

If you think that you may be suffering from anxiety, depression or any other mental illness, you can speak to your GP and ask for help, or contact the Samaritans on 116 123 if you need someone to talk to. If you ever feel suicidal or like you may harm yourself or other people, you should always call 999 immediately.

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6 years ago ·

Understanding: Depression

By Andy – Arch Care Services

Depression is the most common mental illness across the world. The Office of National Statistics estimates that around 20% of the UK population aged 16 and over show some signs of depression. In fact, in 26 countries depression is the most common kind of disability reported. But despite being so common, depression is also widely misunderstood, and there are a lot of misconceptions floating around regarding how depression presents itself and how to treat or manage the condition. This week we’re going to be looking at the causes of depression, how depression manifests for different people, and the various ways that it is treated and managed.

What causes Depression?

The truth is, we don’t exactly know. If you injure yourself physically it’s usually pretty easy to work out how you did it. If you fall off your bike and afterwards are told that you have a broken arm it’s probably fairly straightforward to work out what happened! But if you’re suffering from depression it’s difficult to isolate the exact cause, as it’s probably a variety of things or sometimes nothing specific at all. But we can identify some common trends that seem to apply more often than others:

  • Childhood Experiences

Nowadays we don’t tend to ask people to lie down on the sofa and talk about their parents when they go for counselling, but there is a lot of evidence that suggests that things that happen to us when we’re children can have a major impact on our emotions when we get older. And it’s not always major traumatic events, although these can also cause depression as well. Sometimes it’s a general instability or a lack of support, things that may not seem too significant but add up over the years. It certainly appears that what happens to us when we’re younger can have an effect on our mental health when we’re adults.

  • Genetics

Now we’re getting into the old ‘Nature vs Nurture’ debate! There is a lot of evidence out there that seems to suggest that if we have close family members with depression, we’re more likely to suffer from depression ourselves. Now, whether this is because there is a ‘depression gene’ hidden away somewhere in our brains, or whether it’s because we’re likely to have been brought up and had experiences that are similar to close family members isn’t as obvious, but there certainly seems to be a connection.

  • Life Events

This is one that most people will understand, because we’ve all had sad, stressful or emotionally difficult experiences that impacted us afterwards. The death of a loved one, a breakup or a major change such as a house move or job loss can be emotionally straining, and sometimes that strain can stay with us for a while. For some people, these events can be a trigger for a more serious episode of depression.

  • Physical Health Problems

Our physical and mental health are very closely linked, and changes to one can cause or contribute towards changes in the other. Sometimes those connections are direct, such as a brain injury that may affect the physical structure of the brain, or hormonal problems that impact on the way that the brain produces certain chemicals, or they may be indirect and caused by stress or difficulties in managing a condition, such as chronic or life threatening illnesses, or disabilities that may cause significant changes or limitations to your lifestyle.

Exercise and diet can also affect our mental health, with depression being a common outcome of unhealthy lifestyles and habits. There is significant evidence that physical exercise and a healthy diet can have a major positive impact on our mood, so consider digging out those running shoes! But remember, it’s ok to seek alternative treatments (including medication) if that works for you, lifestyle changes may not work on their own for some people.

  • Drugs, Alcohol or Prescribed Medication

Drug and alcohol use can be both a cause and an effect of depression, which can lead to a vicious cycle whereby people feel low, use drugs or alcohol in an attempt to feel better, which only makes them feel worse, leading to increased use of the very same substances. I could write an entire blog on how street drugs affect mental health, but for now Mind have a fantastic guide.

Depression can also be a side effect of many prescribed drugs, including some anti-depressant medication. Make sure you always read the leaflets that some with your medication and take them as prescribed, and if you have any concerns you should contact your GP immediately, as these side effects can be serious.

The causes of depression are far from clear-cut, and in most cases are likely caused by a variety of different things all acting in conjunction. It’s also important to remember that we all cope with things differently, so people will have varying degrees of tolerance to stress or trauma and will react in completely different ways. The same life event could cause me to become depressed and have no affect on you whatsoever, and that doesn’t mean that you’re emotionally stronger than I am or that I’m a weak person! We are all different and deal with things differently, and that’s absolutely fine.

Symptoms of Depression

Depression has come to be used as another word for sad, so when we say the word depression we naturally think that depressed people must feel sad. Personally, when I hear the word depression the following picture pops into my head:

These kinds of pictures are used a lot in the media when they talk about depression, but they’re not really a good representation of what a mental illness actually feels like. This might be why some people find it really hard to understand just how serious and difficult depression can be. After all, they know what it’s like to be sad, they felt a bit sad last week and then they watched some television and went for a walk and then they felt fine, so why is everyone always complaining about feeling depressed all the time? Since we already know that around 20% of adults will display some symptoms of depression at some point in their lives and that not everyone who has depression is sad all of the time, maybe a better image to use would be something like this:

Or this:

Or even this:

Of course, depression is much, much more than just a feeling of sadness. Some of the most common symptoms of depression are:

  • Low self esteem, or a feeling of worthlessness.
  • Intense sadness or unhappiness that doesn’t improve.
  • Being unable to enjoy or appreciate things that would normally make you happy.
  • Weight loss or weight gain.
  • Sleeping too much or too little.
  • Difficulty concentrating or focussing.
  • A sense of hopelessness or despair.
  • Physical aches or pains, especially in the head, shoulders, back or stomach with no obvious cause.
  • Feeling isolated or detached and avoiding people or social situations
  • Mood swings.
  • Use or increase in consumption of drugs, alcohol or tobacco.
  • Moving very slowly or feeling anxious and agitated and moving too much.
  • Self harm or suicidal thoughts or actions.

Have you noticed that some of these symptoms are complete opposites? That’s one of the most unusual things about depression, it can cause completely different symptoms in different people or at different times, but is still classed as the same illness. One person could be tired all the time and sleep too much, gain weight and struggle to speak to people, and another could lose weight quickly, struggle to sleep and have too much energy throughout the day and they could both be diagnosed with depression. This is one of the reasons why it can be so difficult to identify and diagnose, and some people may be depressed and not even realise it, because they don’t feel sad.

How Depression is Treated.

Unlike some other illnesses, there is no single treatment for depression that works 100% of the time. The treatment plan will depend on the person and their preferences, the symptoms and how serious the depression appears to be. In general, treatment can be split into three groups:

1. Medication

There are multiple different kinds of medication that are used to treat depression and other mental illnesses, all with their own positives and negatives. Some people are nervous about taking medication because they are worried about side effects, or that the medication might take something away from their personality or ‘turn them into a zombie’, and this is understandable but may be based on some misconceptions about how some of this medication works. Some people also say that if you use medication that you are somehow masking the problem rather than dealing with the cause, and that it’s better to deal with depression ‘naturally’. Again, this is an understandable way of thinking about it, but may not be entirely accurate. The evidence suggests that medication can be a very effective way of treating or managing a mental illness, and for lots of people medication has been invaluable. There is no shame in using medication to treat depression or any other mental illness, just as there would be no shame in taking antibiotics for an infection. However, you should always talk to your doctor about any concerns that you might have prior to agreeing to try them out, and follow the instructions carefully. A general guide to the kinds of anti-depressants that are available can be found here.

2. Counselling or Talking Therapies

As I mentioned earlier, this won’t usually involve lying on a sofa and talking about your childhood (although sometimes it might!). Nowadays the main kind of therapy available on the NHS is Cognitive Behavioural Therapy, or CBT for short. CBT can be delivered one-on-one or as part of a group, in person or online, and is a short term therapy designed specifically to help us to understand how we think and behave, and how these things might be connected. It is very practical, so you won’t be digging through your past or talking about previous trauma, it’s more likely that you’ll be exploring tools and techniques that can help to manage low mood as it arises. You can find more information about CBT by clicking here. Availability and access to CBT will depend on your symptoms and the area that you live in, you can always ask your GP about any local groups that you could be referred to.

You may also be encouraged to try out some mindfulness techniques, either as part of a broader course of CBT or more informally. Mindfulness encourages us to focus on our daily experiences in the moment, and spend less time worrying about the future or feeling regretful or guilty about the past. Understanding how we respond to certain triggers can help us to change those responses, although this does take patience and practise! You can find more information about mindfulness here.

More traditional talking therapy is still available, but mostly through private practise and you may need to fund it yourself.

3. Lifestyle Changes

This will generally be utilised when the depression is milder, or used in conjunction with other types of treatment. Changes to your lifestyle, whether that be improving your diet, trying to exercise more, cutting down on drugs or alcohol, considering a change in jobs or relationships or spending more time socialising can have a significant impact on mood, and can play a major role in the treatment of depression. It is likely that this process will be your responsibility, although general advice from a GP may be helpful when starting out. For some general tips about the kinds of habits that encourage good mental health, you can read one of our previous blogs here.

The evidence suggests that people may need to try several different things or a combination of different types of treatment in order to identify the most effective plan for them, and this will often take some time, but that all of these approaches are effective at treating and helping people to manage the symptoms of depression.

To summarise what we have covered today:

  • The causes of depression are complicated and difficult to isolate, and different people will have completely different causes and respond differently to different triggers or life events.
  • Depression is not just a feeling of sadness. Depression can be a very serious illness.
  • There is a wide variety of different symptoms caused by depression, and people will experience it in vastly different ways. The same person may even have different experiences over time.
  • There is no single treatment for depression, and most people will try various plans and combinations of treatments before they find the one that works for them.

If you are worried that you or someone you know may be experiencing depression or any other mental illness, you should either contact your GP or advise them to contact theirs to ask for help. If you need someone to talk to, you can contact the Samaritans for free on 116 123, 24 hours a day, 7 days a week. If you need immediate help or feel suicidal, you should always call 999.

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6 years ago ·

7 Habits that Encourage Good Mental Health

By Andy – Arch Care Services

A healthy mind is just as important as a healthy body, but sometimes we can forget just how important it is to form habits that ensure that you are happy, confident and secure. We all understand that we should eat well and get plenty of exercise, but what can we do to make sure that we are emotionally strong, resilient and content, as well as physically healthy?


1. Get some rest!

Sleep is vital, although the adorable puppy is optional.

We spend around a third of our lives in bed, and sleep is just as vital as eating, drinking and breathing, and going just a couple of days without a good nights sleep can have a huge impact on your emotions, memory and critical thinking abilities. A common misunderstanding of people with mental health concerns is that they should just ‘pull themselves together’, or ‘get up and do something!’, but in reality it’s probably more important that these issues are addressed and understood, as they can often be both a contributing factor and a side effect of a mental illness.

Make sure that you have an established sleep schedule and stick to it. Go to bed at a set time, and this means no television or mobile phones! In fact, it’s probably best to keep screens out of the room altogether if possible, and only go to bed when you intend to sleep. Your brain is fantastic at making connections, and it’s important that your brain connects your bedroom with sleeping. Make sure the room is comfortable and free of distractions, and if you can’t sleep pick up a book and read for a while rather than scrolling through Facebook!

2. Think positive thoughts!

Try to start the day on a positive note!

Sometimes when we feel low, positivity can feel like an impossible task, but there’s loads of evidence that says that positive thinking can have a major impact on your mood, which makes you feel more positive, which increases your mood even further! It’s a fantastic, happy cycle, and we should do everything we can to get ourselves into that cycle.

Start small. Every morning, tell yourself out loud that today is going to be a good day. When something good happens, notice it! We are all excellent at remembering the bad and forgetting the good, try to pay special attention to the good things in your life, even if they’re small. A random encounter with a stranger that made you smile, a particularly delicious sandwich, even something as small as doing the washing up, pay attention to them and remind yourself that they exist.

3. Exercise and eat well

Sometimes something as simple as a quick stroll can make all the difference.

I know it sounds cliché, but the saying ‘healthy body, healthy mind’ is absolutely true! We are biological machines, and if we use the wrong type of fuel or allow our joints to rust then everything else will be impacted. You don’t need to enter a triathalon, or eat only protein shakes and broccoli, you’re not entering the Olympics! Start by getting outside and moving around, even if it’s only for 10 minutes a day. Just a small amount of exercise and fresh air can have a huge impact. Try to make sure that you eat something green with every meal, avoid junk food, cut down on the carbs and sugar, maybe consider brushing up on your cooking skills! You’ll be amazed at the difference that these small changes will make to your mood. And it’s a great excuse to brush up on your cooking skills while you’re at it!

4. Give yourself a break!

Smartphones can be a blessing and a curse!

We live in a high pressure, fast paced world. Social media and the internet mean that we get our information quickly, we’re always on the go, absorbing information and responding emotionally. In some ways this is great, we’re more connected than ever before, we can communicate with friends and family wherever we are, and we have new support networks available to us that we wouldn’t have been able to access 20 years ago. But it can also cause stress, anxiety, a feeling of being overwhelmed and huge pressure to be available at all times. Go easy on yourself! Practise some self care, and make sure you put aside some time for yourself. Go out into nature and spend some time away from your screens, try to reduce the time you spend on social media, and if you’re a news junkie like me, maybe consider reducing the amount of time you spend reading about current affairs! It’s alright to have some downtime and focus on things that relax you and make you feel happy, whatever those things may be.

5. Pick up a hobby!

Learning to play an instrument is a fantastic creative outlet!

One of the best ways to maintain a healthy mind is to keep your brain active and occupied. If you have a hobby already, try to make sure that you keep it up. One of the first things that we tend to do when we feel low is stop doing things that previously made us happy, and it’s important that you avoid that if possible. If you have lost track of your hobbies, don’t worry! Just try to take some small steps to pick it up again and get back into it. Or maybe consider something entirely new! It could be anything, from sewing to fishing to whittling to collecting stamps, anything that interests you and gives you something to focus on in a positive way. The internet is an incredible resource for picking up information about possible new hobbies that are cheap or free and can be started almost immediately. Some of them may even have local organisations or clubs that you could attend, which has the added bonus of encouraging you to meet other people with similar interests. Don’t worry if this doesn’t appeal, there are plenty of hobbies that you can do on your own if that’s more your style.

6. Be mindful!

Take time to stop and appreciate your surroundings.

Mindfulness is a technique that teaches you to try and focus on how you are feeling in the moment and paying attention to physical sensations and emotional reactions. There is a mountain of evidence that suggests that practising mindfulness regularly encourages us to let go of negative encounters from the past and anxieties about the future and pay attention to our experience of life as it occurs. Try to pay attention to the physical sensations, sounds, smells, or tastes of your day to day routine, notice how things make you feel and how your body and mind react to them. Don’t try to deny emotions or run away from them, just notice them, understand them and move on. Don’t worry if it doesn’t work immediately, mindfulness is a technique that takes practise and needs time to develop, but if you stick with it then it will help enormously.

7. Open up!

Sometimes a friendly word from someone you trust can make all the difference.

Despite all our best efforts, it can sometimes still feel difficult to be honest about your struggles with mental health. We don’t always know how people are going to react, and that can be scary. But being honest with yourself, allowing yourself to be vulnerable, and asking for help is a really important part of staying mentally healthy. We’re not made of stone, everyone struggles sometimes, and the best thing we can do for ourselves, and for everyone else, is to be honest and open. That could be something as small as calling a friend and asking to talk, or going online and finding an anonymous support network if that’s easier, or it could be something bigger like calling a doctor and asking for help or attending a local support group. Whatever route is best for you, talking to other people and asking for advice, support and guidance can be an incredibly fulfilling experience. And who knows, maybe one day you’ll be the person that someone turns to when they need help or advice, and you’ll be able to offer them the same help that you received when you needed it the most.

It can be easy to forget just how important it is to look after our mental health, but if you take steps to embed healthy habits now, they will pay off in the future. The steps above are a great place to start!

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