As is probably true of us all, I’ve been pretty down this week. I’ve been struggling with concentration, sleep, and general irritability. Although I would no longer classify myself as depressed, I am aware that my moods fluctuate quite a lot, and I do what I can to keep them in check and generally don’t feel like I do too badly. So I was a little surprised yesterday when one of my best friends said she thought I should see a psychiatrist.
I’ve been thinking it over ever since and it has made me aware of several things. Even people who have experienced mental illness, talk about it a lot, seek treatment for it, and understand what it’s about, do not always like being told that they need help. I don’t want to be one of those people who refuse treatment when people around them think it is needed. But it is a horrible feeling, perhaps even more so if you have had treatment before and improved, because it makes you feel you have failed by being ill again.
In my case, there is also apprehension and scepticism over what a psychiatrist can do for me, and how that would work in practical terms. In the past four years I have had two years of counselling, six months of antidepressants, six sessions of CBT and a prescription for anti-anxiety drugs (I only took one, which made me feel so ill I could hardly sleep, work or eat for 24 hours. Apparently this is common and can last up to six weeks, and as I have very little excess body fat, I thought it was better to be mildly anxious than starve). I do not really want any more talking therapy. I know the background of why I am anxious, and sometimes low, and I don’t really feel that talking about it any more will make it any better. I don’t really want to try pills again – my main issue is low self-esteem and sadly there isn’t a pill for that. The side effects when I have taken them before were also rather troubling and off-putting.
The conversation with my friend focussed my mind on what I’ve been wondering on and off for the last couple of years, or even longer than that. Am I ill, or am I just me? There are so many ways of interpreting our behaviour and thought patterns these days, with so much more knowledge of mental illness freely available, that it all too easy to label someone as one thing or another. Here’s a good example of what I mean: when I was at school, I used to hate being asked to answer a question unless I was 100% sure of the answer, and that was rare. I was terrified of getting it wrong. Various books I have read over the last few years have included examples of this and attributed it to a different ‘label’. Quiet by Susan Cain says this is introversion. Sheryl Sandberg in Lean In says this is common among females, because we are socialised not to consider our answers important and to be quiet and shy and let the boys speak. Or you could say this is the beginnings of anxiety, a deep-based fear of being found not good enough that requires therapy or pills to solve. Or is it just me? Just the way I am, that I don’t like talking about things I don’t know much about? I don’t know. It could be any of those things, or none, or all. So how do we know when we are mentally ill?
When I was at school or doing my BA, the label ‘anxiety’ was not that common amongst teachers so you just had to get on with it and do the best you could. I know that universities are far more aware now and some make special provisions for students who experience anxiety, particularly for presentations (I don’t know about schools; I’d be interested to learn). This is good in some ways, because people can get help and support, but it can also reinforce negative behaviours. Using the example of presentations, if my teachers at university had known that I was so nervous I thought I was going to be sick before each public speaking effort, and so anxious during those five minutes that I couldn’t breathe properly, maybe they would have let me off. I would have been so relieved, and I am a little envious of the students who are let off now. But: avoiding what makes you anxious in this way does not do you any favours. If you never try, you never learn that it doesn’t kill you, and you never improve. By the end of my BA degree I could do a presentation with far less nerves, and my audience would be more or less unaware that I was anxious at all. It is still a problem for me, but I learnt that I could do it. Not facing these anxieties is called negative reinforcement: the immediate relief of being let off is so marvellous that you keep doing it again and again, and you never get any better.
So is it useful to give yourself a label and use it as an excuse? For things that make everyone anxious (public speaking is one of the most common phobias) maybe it isn’t. And I can’t say I’m generally anxious because a lot of things that some people loathe I have no issues with. I adore flying, for example. I get anxious before some big social occasions where I’m not going to know many people, but who doesn’t? I now get anxious when I drive because I haven’t done it much lately, but again, isn’t that normal?
Another example I read about was a girl who lost both her parents very early in life. After the death of her mother when she was only about 20, leaving her an orphan, she went to see a counsellor. The counsellor told her she was ‘ordinarily unhappy’ and for a long time the girl was livid. But the counsellor meant: of COURSE you are unhappy. Who wouldn’t be? And in some cases this is a useful way of looking at things. You’re nervous of talking in front of 30 other people you hardly know? Fair enough. It’s not unusual. It doesn’t need a label.
My friend is worried that I may still be suffering from a form of depression, which may have been misdiagnosed by a GP without the time or expertise to look into the problem fully. By the standard definition of feeling down and hopeless and plagued by negative thoughts for two weeks or more, I am not depressed. I have been low this last week, and anxious, but again with all the news this past week or two, WHO HASN’T been feeling down and anxious?!
I do know that there are some things that are not perhaps ‘normal’ for me to worry about as much as I do. And I could call that anxiety, as they can get into self-reinforcing and self-inflicted spirals. But most of them are to do with self-esteem: am I good enough at this? Do people like me? Am I important? Am I pretty enough? Am I clever enough? It’s exhausting. But it’s not constant. So is it an illness, or is it just something people suffer from – particularly women?
I have been listening to the Guilty Feminist podcast a lot lately – highly recommended – and listened to one yesterday on Worth. They discussed how much they felt they were worth, both in monetary terms for their jobs but also in terms of standing up for what was important to them, and measuring their own worth by different standards. Sarah Millican was the guest, and she said it had taken her a long time to work out that she needed to judge her own worth herself, without taking on anyone else’s assessment. She read out a review she had had after appearing on a television show where the reviewer essentially pronounced her worthless because she was not young and sexy, but neither was she a wife and a mother. Too often women have their worth judged in these ways, rather than on anything else. It’s a huge problem, because when women judge their own worth in this way, even if they wouldn’t judge their friends like that, it’s easy to feel worthless. Oh, my boyfriend didn’t want to sleep with me this evening therefore I’m not sexy therefore I am worthless. I am single and in my thirties and don’t think I want children therefore I’m worthless. I’m in my fifties and have been at home raising my children for thirty years, but now my children have all left home and don’t need me every day anymore therefore I’m worthless.
I am well aware that I have issues assessing my own worth, and believing that I am not worth much leads to problems all over the place. If I don’t think I’m worth much, I don’t understand why my partner would think so, so I think he’s going to leave. I get irritable and needy, and then he gets upset, and then I feel even more worthless because I’m being a pain in the arse, and the cycle keeps going. This, I think, is what my friend thinks I need a psychiatrist for, and probably because she’s heard stories of these kind of issues with my partner too often for too long, and there’s nothing much she can say, or anyone can say – except perhaps a professional. Maybe she’s right. I know what the psychiatrist will say, but is that a reason not to go? Do I need a label? Or can I cope with this on my own? Is it an illness that requires treatment, or is it because I’ve grown up as a slightly introverted woman and these are common tropes in many women’s lives? I really don’t know.
I am considering going purely for the guidance of a professional opinion. At the same time I am aware that my best friend in all this is probably myself. If the worst problem I have is negative thought spirals, the best thing I can do is practise mindfulness. When I did it actively for a few weeks, I procrastinated less at work, I got into less idiotic thought patterns about my partner’s ex-girlfriends (of ALL the pointless things to think about, that’s got to be one of the worst) and I felt much better and more confident in myself. We have been told time and time again that exercise is effective as medication for some mental illnesses. So even if a professional would give me an anxiety or depression label, does that also mean I need psychiatric treatment? If I don’t think I need it, odds on it won’t work. So ultimately, my opinion is the one that’s worth the most.