I write as someone who's pretty much had mental health difficulties all of my life. Once upon a time I would've been embarrassed to admit that, but not anymore. I've realised there's no shame in mental ill-health and I now talk more openly about it, as I believe this helps to de-stigmatise it.
Diagnoses, and lack thereof
I've come to believe I've undiagnosed ADHD from childhood. And that has always tended to bring with it criticisms of being disorganised, scatter-brained and even lazy. You get told that enough throughout your childhood (and adolescence, and early adulthood) and at a certain point you internalise it. Not to mention all the time spent comparing yourself to others.
ADHD also brings with it anxiety and overwhelm from constant efforts to mask and fit in.
Then there's the rejection sensitivity, sometimes known among sufferers as rejection sensitive 'dysphoria'. If you don't know what RSD is, it reflects an inability to regulate emotional responses to stimuli. And having what would be perceived as exaggerated reactions, disproportionate to that stimuli. For example, an argument with a friend in the mind of the RSD sufferer means that the friendship is over, you'll never speak again and you're a terrible person. With all the emotional anguish this perceived reality brings with it (albeit -generally- temporarily).
I was a highly anxious and neurotic child, teen & young adult, eventually getting diagnosed with generalised anxiety disorder. (How much of that's related to the ADHD and how much is a whole separate thing will -I guess- never be known.)
Chronic physical ill-health, an unpaid caring role alongside full-time work and chronic work-related stress later added depression into my collection.
Attempted treatment
I was first offered treatment by the department of psychiatry in my early 20s for social anxiety. But I felt -at the time- that the CBT which was offered to me was not a good fit, and I was unable to engage with it.
People I see stuck in mental distress
Now, with the benefit of age and experience, I sometimes see others who I feel are in a similar position. People who are having chronic mental health difficulties, and seem to be stuck there.
I imagine there are a number of reasons for being stuck (not having found a source of support or a therapy type which is a good fit, for example). But I wanted to address one of those reasons in this blog post.
I see people who either won't seek help, or have had some help but been unable to take it on board and allow it to improve their situation. Like when I was in my 20s and couldn't engage with the CBT which was all that was on offer.
In part being-unable-to-engage was due to it being uncomfortable. And my lacking awareness that the discomfort was something which needed to be tolerated to come through the other side and begin to have a better experience. (And, as I've come to learn latterly, that distress-tolerance is actually even a useful technique to practice.)
But I think part of it was also an extremely low sense of self-worth. A subconscious part of me didn't think I deserved to feel better. I somehow deserved to be punished, so I stayed stuck in feeling bad.
A possible root cause?
The people I see around me who seem unable to move on into that better experience? I feel like a lot of them are likely stuck, the same way I used to be.
Someone in their life taught them -through their words, actions or lack of action- that they didn't deserve any better. Abuse, bullying, neglect, coercive control. These are things which are inflicted upon people. And the perpetrators want their victims feeling low, so that they won't stand up for themselves or leave. This doesn't mean that it's in any way deserved. But -sadly- the insidiousness drives the message deep into a person's subconscious.
In my case -looking back- it started with the RSD in childhood and some bullying in school, then was really compounded by an abusive intimate partner in my mid-late teens.
I've seen people for whom it was caused by bullying. I've seen people for whom it was either a neglectful, a hurtful or abusive parent. I'm sure it could be caused by teachers, coaches and other such figures, even. Or a combination.
And as we know, a lot of folk who've experienced harmful people in their lives tend to find themselves attracting more damaging people in their relationships going forward. It's that insidiousness, again.
Recommendations
So, what do I -a layperson, but with lived experience- recommend?
- First and foremost, allow yourself to believe that you deserve to feel better. It may be easier said than done. But for almost everyone on earth, there are people who care about you. So if you can't yet accept that you deserve this for you, then do it for those people in the beginning. You'll be in a position to be a better friend/spouse/co-worker/team-mate/neighbour once you start working on yourself. And if you're currently socially isolated, know that starting to feel better in yourself will undoubtedly put you in a better position to start making new connections.
- Reach out for help from services when you feel you need it, but do be aware that the first thing which comes along may not necessarily be most appropriate for you in the long term. You might need to have a little bit of patience & perseverance before you're able to get into your stride. Don't give up.
- With the above in mind, if you can afford to shop around, it's fine to shop around and find a good fit.
- If you can't afford to shop around and instead have to rely on free help (like here in the UK under the NHS) it's still okay to ask the question as to whether you can speak to someone else if you don't mesh well with the therapist. It's not a personal failure of yours if that happens -- it's going to be vital that you feel you can open up to the therapist; so if that doesn't seem like the case, then you're entitled to at least ask about the alternatives.
- Try to be open minded about the type of therapy offered. And actually give it a fair go. It isn't meant to be comfortable, certainly in the beginning. But it also isn't powerful enough to work after only 1 session, so you're going to need to persevere for a while. (This is another reason why finding a good fit is important if at all possible.)
- It doesn't necessarily have to involve talking about past trauma, at least not extensively. A therapist will likely want to have a rough idea of your background, but a good one should understand if you'd rather focus attention elsewhere. For example, you may chose to look at specific goals, or practical exercises to help with your chosen areas of concern. In fact, they'll likely be encouraged that you've done some thinking about what you want to get out of therapy.
- Reflect. Whether you're having face-to-face sessions or online, try not to be intimidated by periods of silence -- reflecting on your thoughts is important, and helpful, so see silences as a chance to do so.
Try to reflect between sessions as well, and even make notes to bring to your next session. (If you're following some sort of online course involving reading material &/or written exercises, or reading a book, you can still reflect and re-read sections.) You can even discuss the material with a trusted confidant in between sessions if you feel comfortable and have someone in your circle who'll be supportive with it.
In the meantime...
What if you're not able to access therapy right away? Or you're in the process of finding that good fit and haven't found it yet?
- The 1st bullet point above still applies; you deserve to feel better. This is probably the most important of the bullet points. Take steps to address how you're feeling -- seek out books &/or online resources. I highly recommend Why Has Nobody Told Me This Before by Dr Julie Smith. It's available on Audible, as well as in hard copy. I will also put a list of other resources at the end.
- If you haven't already, try to confide in a friend, family member or other trusted confidant as to how you're feeling. You don't necessarily have to go into details if you don't feel comfortable. But having someone who knows a little about what you're going through at least means you can express it when you're feeling low. They might be able to give a gentle pep talk, or just a hug (depending on the relationship you have). Or at the very least they can probably help take your mind off things temporarily by doing something together.
- Self-compassion. Once you've taken on board that you deserve to feel better, try to cultivate some self-compassion. All of us have automatic negative thoughts, and they keeps us stuck feeling badly about ourselves. The first step is to try to spot these thoughts. It doesn't necessarily work so well just think the opposite of them right away. So -for now- try to alter them into something neutral instead.
When you catch your brain thinking: "I can never seem to make small talk", don't try to pressurise yourself into thinking you're amazing at small talk. But instead, tell yourself you just need more practice, like a lot of people. Try to gradually change the negative self-talk into neutral, and in time you'll find you're ready to start giving yourself pep talks, like those you'd give to a good friend going through a tough time. - Self-care. I know it sounds corny, but allow yourself to have regular self-care on a daily basis, as a minimum (preferably two to three times every day). It doesn't have to be a long soak in a bubble bath (though it can be if that's your thing). It can be taking a little extra time to make yourself something healthy to eat, or taking a walk outdoors. It can be taking a few minutes to sit down and savour a beverage during an otherwise busy day, or even just sitting with your eyes closed for a few minutes.
Whatever it is, pick something which -to you- represents self care -- maybe make a list of self-care activities in a little note book and keep it with you. Self-care is a way of demonstrating to your subconscious that you deserve to feel better. - Consider journaling. I've not been very successful at this one myself (my mind always goes blank when I sit down to write) But lots of people have recommended it to me. It turns out, as well, that there are lots of different types of journaling you can try, too. So I recommend an internet search for journaling techniques, to find one which appeals to you.
[I will add one note: when I have tried journaling to get the distressing thoughts and feelings out, I've preferred to write it on a loose leaf of paper, and then dispose of it rather than putting it in a notebook or journal which I'm intending to keep. But I do also know that some folk like to look back at past entries to look for patterns, or to see the progress they've made. So, it's one of those personal preference things.] - Affirmations, but this one has a couple of caveats. The first caveat is that I believe manifestation has it's limitations and isn't a panacea or cure all. So make sure you don't make it your only approach.
The second caveat is -from personal experience- the affirmations you choose need to resonate well with you as an individual. Because -from personal experience- if you try to tell yourself something which your mind sees as outlandish, it will contradict you (at least mine does, anyway!) For example, if you try to tell yourself "I'm perfectly happy", the next thought to surface is likely to poke holes in that, such as "that's bull, I'm actually really stressed out..." And that just seems counter-productive.
So, be choosy, especially if listening to audio recorded by someone else.
You might also like to try this grounding technique instead from the Therapy in a Nutshell YouTube channel, at least to begin with: Relaxed Vigilance. - Relaxation &/or grounding exercises. Lots of us get stuck in fight-or-flight mode, making relaxation really difficult (search the term 'nervous system dysregulation'). But know that relaxation doesn't necessarily just arrive after you finish work, or get home from doing grocery shopping, or whatever. Very often you need to go after it, proactively. And it doesn't just mean watching the television or playing video games (indulging in some of that's fine, just not too much).
Now, along with journaling, I struggle with this one (despite it feeling good when I do occasionally take that long, slow breath). So, rather than recommending specific relaxation techniques, I'm -again- going to suggest doing an internet search.
And if you spend the last chunk of your day -say an hour or so- before bedtime doing your relaxation, it's likely to help with sleep. But do set aside time for this after your TV or video gaming session, ideally every day. - Mindfulness is really big these days. I've listed it separately to relaxation, because mindfulness doesn't have to represent an hour out of your evening (nor even 20 minutes). Instead, mindfulness can feature at intervals throughout your day. Plus, I wanted to talk about different types of mindfulness. I'm heading this one: think outside the box. In other words, find what works for you as an individual.
For example, I've heard some stuff about mindful eating. But, you don't necessarily have to savour only the flavour of the cup of tea or bowl of soup. You can sense the warmth and texture of the cup in your hands, if that works better for you. You can watch the swirling of the steam in the air.
If -like me- you struggle to do mindfulness purely within the mind (if that makes sense), try something else that's tactile. Cup your face in your hands; notice the relative temperatures of the skin of your hands and your face. Focus on keeping your spine in the optimum position for a bit, but without tensing -- turns out it may take more concentration than you might think.
Or, you could try something visual -- try to memorise your toes, or trace the tangle of branches in some trees with your eyes and just allow yourself to get lost.
Just pick something mindful to do at regular intervals that works for you. Get out of your own head, as they say. Reconnect with your body a little. And know that it's giving your mind a little break each time. Plus you're cultivating a healthy habit which will only become stronger over time.
These last two, relaxation and mindfulness, can really help with the mind-body connection. So, whilst -on the face of it- they might not seem to be helping directly with feelings of low self-worth, they'll help to regulate your nervous system. This, in turn, will help send signals from your body to your brain that all's well. Plus these activities also come under the category of self-care.
Finally, exercise is also meant to be really helpful with depression. So it can be extremely helpful to find a physical activity you enjoy doing and take up doing it regularly. If -like me- you struggle with regular exercise, at least know that movement can be helpful in moments of anxiety and stress. Even if all you do is stand up and shake out your hands & feet for a few minutes.
When you've come to the end of the bullet points... go right back to the top and begin again. (Or, just pick a random one anywhere in the list. Or, for that matter, if the above list doesn't speak to you, come up with your own ideas and practices.)
You see, this isn't a one-off exercise, it's a process you want to make into a well-established habit, like training a muscle via gym equipment.
And hang in there. You do -I'll say it again- deserve to feel better.
Other resources to consider exploring
- Apps for self-care posts: post 1 (from June 2020) and post 2 (from January 2022)
- CIMHS/Bliss Free Online Therapy for Depression free short course
- Crappy Childhood Fairy free online resource (e.g. daily practice)
- Empowered Self - The Somatic Strength Collective (free 7 day trial)
- Every Mind Matters - NHS
- Getselfhelp.co.uk
- Meditainment | Guided meditation and visualization
- Meditation - HelpGuide.org
- Mental wellbeing audio guides - NHS
- 'Overcoming' Apps
- Psychkit.org
- Rhythm of Regulation Meditations
- Self-Administered EMDR (Is it A Good Idea For You?) - YouTube
- 750words.com -- daily writing habit site
- Side by Side | A community platform by Mind
- Therapy in a Nutshell | How to Process Your Emotions - YouTube (see Somatic exercise - The Robin, in particular, and also 6 Keys to get WAY more out of therapy may be helpful too)
- Wellbeing Support | Activities & ideas | British Red Cross
- Wysa - Everyday Mental Health app
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