Don't Blame Me For What You Cannot See (mental health awareness)

A family member recently said to me that if he knew somebody with anorexia he would tell them to 'just try and eat something' and that he would ' reassure them that they weren't fat'. It came from a good place, by a good, kind person but it blew my mind how little people understand about mental health conditions. I tried to explain that when a person with an eating disorder looks in the mirror they see a completely distorted over weight person, even when their bones are visible and they are dying of malnourishment. He still didn't get it. It made me think. In the hope of gaining understanding of my own mental health issues ( I have PTSD, PMDD and the associated anxiety and depression that comes with these conditions) I've been advised many times to go down to the doctors without make-up on or following a panic attack when my eyes are all puffy and swollen. However, hearing my family members thoughts on eating disorders made me realise that even when something caused by a mental health disorder is very visible on the outside people can still fail to understand. Why is this?

An ex partner once said to me 'you're very passionate when talking about how other people don't understand your illness aren't you?'. If these words had come from a supportive place I would have taken that as a compliment but they didn't, so I didn't. For a long while he pretended to but he didn't understand any of my conditions and never had. He was trying to make me question myself, and he succeeded. These words stuck with me though and I started to see it as a huge positive instead. Yes, I am passionate about gaining understanding, and rightly so. We live in a world where the estimated number of people living with invisible health conditions is rising yearly and these people struggle daily trying to get people to see beyond their external appearance. A shocking statistic is that one in fifteen people will make a suicide attempt at some point in their lives. Mental health conditions are at an all time high pushing the NHS to breaking point as they fail to find beds in over crowded and under funded psychiatric wards. There has been so many cases of suicide recently in the celebrity world and finally we seem to be discussing it more openly yet people are still shocked when the next smiling, 'happy' reality tv star/actress/singer takes their own lives. Depression and anxiety are illnesses the same as any other serious illness but the disease is located in the brain, out of sight, not on show.  Cancer kills people but how can we not understand that when it ends in suicide so does depression. We wouldn't dream of telling someone to think their cancer away so why is it deemed acceptable to tell a sufferer of depression to 'think of something nice' in order to make themselves well again or to 'switch it off'?

Apart from choosing what we put into our bodies to nourish them we have little control over our own internal organs. If someone has a problem with the way their stomach is functioning we don't question or blame them so why do we question people who have an illness that is simply caused by the way a different organ in the body is functioning? why do people assume that the brain is different? is it because we use this organ to think so people believe we can simply think it better or imagine it away? The brain consists of three main parts and it is such a busy organ with so many jobs to do it's no wonder it gets overwhelmed. I try to imagine it as a huge version of Birmingham's spaghetti junction with cars zooming all over the place. Chemicals produced within the brain (our major organ) are one of the main causes in the majority of mental health issues. Our moods are affected by how these chemicals are produced, the amount that is produced, how they are regulated or our sensitivity to these chemicals and we have no (or very little) control over these factors. Of course, exercise, relaxation and thinking positively can all benefit our mental health but in the same way that they cannot cure cancer, they cannot cure depression. So it does make me angry. It makes me angry every time someone questions what I have to be sad about (when sad doesn't even come close to the feelings created by this illness), or when someone says suicide is selfish, or when people tell me to 'just think positive'. A person with depression doesn't want to feel depressed in the same way that someone with a bad migraine doesn't want a bad migraine. The migraine sufferer can take tablets to ease the migraine but ultimately they have to ride it out and hope that it eases off. The same applies to a person with depression yet the medication doesn't always work.

I have tried many times to describe both anxiety and depression to people who have never experienced it. With depression I use this description a lot. If you are in a bad place with your depression you could sit in front of the tv holding the winning lottery ticket and still feel nothing. Of course, unless your depression is caused by financial difficulties then all the money in the world wouldn't make any difference to your depression but I am trying to say that something exciting, a dream coming true, wouldn't make any difference to your mood in that very moment. Another example is your perfect wedding day that you have imagined your whole life. There you are standing next to the love of your life and everyone is smiling and happy and beautiful yet you stand there feeling lost, empty and hollow.  Imagine how this feels and the guilt and all other associated feelings that stem from feeling like this on such an important day and yet it has nothing at all to do with the person you are marrying or the ceremony but everything to do with your illness and again you cannot control it. Depression is an illness not just an emotion. It is not just 'feeling sad', we all feel sad from time to time, we do not all feel clinically depressed. Depression is extreme sadness, extreme low mood, emptiness, worthlessness, hollowness, fear, self loathing and more and it hides itself well which is why we are so shocked that it takes the lives of comical, seemingly happy people such as Robin Williams. I have actually found that a very high number of people with severe depression are extremely creative, artistic or effervescent people that we perceive to be extrovert. This form of depression has been labelled as 'smiling depression' where the person appears happy while internally suffering with deep depressive thoughts. They wear their smile like a mask but it is simply a defence mechanism for them to carry on their daily duties. Suicide is a particular threat for these individuals because unlike those suffering with classic depression (and the associated lack or energy and motivation) they have the energy and ability to plan and follow through. This is why so many celebrities whose careers are built on entertaining shock us with their sudden suicides.

When it comes to anxiety it seems to be harder to explain but easier for people to understand and this may be because everybody worries to some extent. I trawled the Internet in search of a good description and here are just a few I found. One user described her generalised anxiety disorder as if she tripped and the moment where you don't know if you're going to catch yourself or not is how she feels all day long. Another similar description was the feeling you get when you tap your pocket to get your wallet, and it's not there but having that feeling constantly and being unable to get rid of it. Anxiety to me is like worrying about every single possible thing, all at once. It is when your mind imagines the worst outcome to everything and replays all the distressing things that have ever happened to you over and over again like a bad song stuck on repeat. It is thousands of questions in your head at once and yet there are no answers. A lot of anxiety sufferers have also experienced panic attacks. A panic attack is a sudden wave of intense overwhelming fear that can strike out of the blue, without any warning, with no clear trigger and can even occur when you are relaxed or asleep. It is charactised by its debilitating intensity and symptoms include but are in no way limited to, a pounding heart, shaking, feeling detached from your surroundings, hyperventilating (over breathing), feeling light-headed and believing you are going to die or go crazy. When I have them I can feel completely detached from my body and I am physically unable to speak. I feel like I have fallen down a deep hole I can't get out of then the crying starts and gets so intense I struggle to breathe. I see no way out and I feel like I am literally losing my mind. After the panic attack I feel exhausted but I do feel some relief at letting out the emotions.

I have lost count of the amount of time friends and family have told me to 'just stop thinking about it' when I am worrying excessively and my anxiety is severely affecting me. The best thing I have found to say to people is to try 'the pink elephant experiment'. For the next 30 seconds you can think of anything you want to but whatever you do don't think of pink elephants. Did you manage it? I often take it a step further and this helps them understand not only the inability to switch off unwanted worries/thoughts but also the fear anxiety creates. Now, Imagine you are in the house alone at night and you know that an escaped murderer has just broken in and is carrying a knife. You must not think about that murderer, imagine he isn't there. Impossible, right? Well that is anxiety at its worst. Extreme fear and unwanted thoughts you can't get rid of. In psychology this phenomenon is called the 'ironic process theory' whereby deliberate attempts to suppress certain thoughts actually make them more difficult to ignore and more likely to surface.

Anxiety disorders are also caused by hormones that are released in the brain. Anxiety becomes a problem when areas within the brain either function inappropriately or fail to function at all. This can be caused by an abnormal fight or flight response which is a physiological reaction that occurs in response to a real or perceived threat. The release of hormones such as adrenaline and cortisol prepare the body to react to an extreme danger and it is believed that the fight or flight response was developed within the human body when our ancient ancestors were around. The scene I always remember being told about was a caveman facing a hungry tiger. What's does this caveman need to do in order to survive ? He needs to either fight it off or run away and in order to fight or flee the body must prepare itself for action by producing hormones that create a whole host of symptoms. In this modern age we are less likely to be faced with a tiger but we still encounter real or imagined threats or stressors and our bodies respond in the same way as if a tiger were in front of us. Now, if you have an anxiety disorder your fight or flight response is malfunctioning in a way that causes you to experience the effects of the hormone release but without a justifiable cause. It is basically triggered when no or very little danger is present. Using MRI scans scientists have shown abnormalities within the brains of patients with both Major Depressive Disorder and Social Anxiety Disorder, but not enough research has been done yet and it is still on going. As with depression it is the brain, an organ, that is not functioning correctly and yet again sufferers are made to feel weak for struggling to control it.

I realise that I have to accept that if someone hasn't experienced serious mental health issues themselves then they will struggle to understand yet it is still frustrating. A bit of reading up, of listening to people's stories, of asking questions and of opening your mind is all it really takes. If you have time to watch TV, or to read a newspaper, to browse Facebook or talk to someone on the phone, then you have time to learn about mental health. YouTube is full of information as is Google. Research and love. It is just two things but it could save someone's life, especially if you are the one that they turn to for support. Take care people and thank you for reading. X

Male depression and why we need to get men to speak up not man up'

Suicide in men has been described as a 'silent epidemic'. In comparison to women, men have a shockingly high death rate from suicide. In fact they are three times more likely to kill themselves and the suicide rate amongst men is at it's highest since 2001. Self-harm rates have tripled and there has been an 165% increase in prescribed antidepressants in England since 1998. However, the majority of prescriptions written for these medications are written for women. Today, around 13 men in the UK will kill themselves (according to latest figures 4,858 men killed themselves in 2013) and the question I want to ask is why is this number so high?

The Samaritans lists 'emotional illiteracy', 'relationship breakdowns', 'unemployment' and 'the challenges of mid-life' in the top 6 reasons for men taking their own lives but I blame society for constantly reinforcing gender stereotypes. Last year a man I know tried to take his own life in a very disturbing, planned out way.  Fortunately he didn't succeed in his attempt and is now recovering well. The saddest thing was that he had felt unable to confide in anyone about how he was feeling. It hurt me to realise how alone with his feelings he must have been. Suicide is not as some people say, 'selfish'. Imagine how low you would have to be to get to the point where you think removing yourself from life is the only option. Depressed people may believe that the world is better off without them or that death is the only way to escape their intense emotional pain. Because that is what depression is, pain. The feeling of being stuck in a vacuous deep black hole that is consuming you. I know it well yet thankfully I have never attempted suicide. The man I know was so deeply depressed he planned his suicide in such minute detail over several weeks yet he couldn't speak to anyone about his thoughts. Why is this?

We live in a world so desperate for equality and so against discrimination yet it seems that men are still expected to conform to society's outdated stereotypes of masculinity. Rarely does society actually emphasise with the causes of male depression and instead many different derogatory sayings are thrown at men who are in touch with their feelings. The amount of times I have heard people say 'Man up' , 'grow some balls'  or 'only girls cry'.  Far less men are actually diagnosed with depression than women and the reason for this may be the fact that men are less likely to visit the doctor to talk about their mental health because they want to assume the alpha-male role and appear invincible. More women than men complain about sexist behaviour yet the fact that society still says 'real' men should be stoic, independent and strong is just as bad if not more harmful than saying that women belong in the kitchen. This intense pressure means that most men feel responsible or in charge of their families' lives either financially or as 'head of the household' and they may worry that admitting that they can't cope would be a sign of failure. This is the biggest misconception because in reality depression has absolutely nothing to do with being weak or having failed and is usually a result of a chemical imbalance in the brain or the pressures of the modern world. Winston Churchill was a great leader yet he suffered massively with what he called his 'black dog' of depression and many highly talented and successful men suffer with depression.

It seems that there is a lot more awareness of the different types of mental health issues that affect women yet little to nothing about the issues men face. For example, the last decade there has been more awareness and understanding of Post Natal Depression in women yet if a man claims to have it he is laughed at. Admittedly a man doesn't have the same biology as a woman and therefore doesn't go through the same hormonal and body changes but having a baby is a huge lifestyle change for both the sexes. Changes affect people in many different ways and although it may be far less severe than the female PND a man can struggle after his partner gives birth. A baby brings about many life and relationship changes and men can feel like they are pushed to the back of the queue or that they aren't needed in the same way as the mother is. Some men also struggle to cope after witnessing their partners give birth because seeing it has traumatised them. Most men who feel like this wouldn't speak out for fear of being judged a bad father/partner, or again, being viewed of as weak. This is just one example of how male depression isn't taken seriously or discussed but obviously there are many different reasons why men can suffer mental health issues, some of which we may not even be aware of. 

Men aren't robots, they don't have the ability to turn emotions on and off. Men are human beings the same as women are. Human beings have emotions and the capacity to show them and denying someone this freedom of expression can internalise the pain. Statistically men are far more likely to use drink, drugs or alcohol to self medicate instead of talking about it. Repressing strong feelings such as anxiety can cause anger and an externalisation of mental distress resulting in destructive behaviour and even an involvement with the law.  It is a fact that 90% of male prisoners have mental health problems and that this is far higher than the percentage of female prisoners suffering similar issues. We really need to get men to drop this 'macho mask' and in order to do this we need to move on from the ridiculous image of masculinity that we have created during the last two centuries. If we look through history our predecessors held completely different views. In Ancient Greek culture men were expected to cry if their family's honour was at stake and one of the greatest signs of true manliness was to shed tears. In fact, this idea was spread through many cultures and up until the 19th century a man who could cry was considered to be a very strong man, capable of showing his weaknesses and proving that he cared about life. Crying is a very powerful proactive way to counteract the  adverse effects of stress, depression and anxiety. Tears contain a natural painkiller called leucine enkephalin and tears that are produced by stress get rid of chemicals that raise cortisol, the stress hormone. A 2008 study at the University of South Florida found that crying can be self soothing and that the shedding of tears can elevate moods better than any antidepressant. We really need to stop just dealing out pharmaceutical remedies and start talking more. As a society we have a responsibility to look at how we enforce and promote such damaging and old fashioned beliefs. Parents should help their sons to grow up able to appropriately and securely show their emotions in times of pain, grief and sadness as well as in times of happiness. It should be taught that it's ok for boys to cry or be vulnerable. Breaking down the stereotypes is the key to dispersing this 'silent epidemic' and significantly reducing the suffering and the suicide rate in men. From time to time remember to ask the men in your life how they are feeling and next time you think about telling someone to 'man up', try to think about the negative message you are unconsciously sending out.  We need to make a change in order to save lives. Thank you.