Mental Health – Psychotic or Self-managing?

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In March 2021,?Jonathan MacDonald,?Kaur Lass, and?I?had a conversation about Mental Wellness Habits, and this series of articles is based on those conversations.

Important: mental illness may require medical intervention. Check out?nhs.uk/mental-health/?for important information.?

It's hard to miss the increasing call for us to talk about our mental health. The guilty secret of mental illness that has haunted individuals and families is giving way to increasing openness and recognition that mental health is an issue for us all. If this were 25 years ago, I'd be very reluctant to share my experience of a very severe manic episode that I had in my late teens. The stigma could impact both my career and my social circle. When I look back on it, I was very ill. What initially presented as a young person behaving bizarrely in the streets of Oxford – presumed by the police as due to drugs – marked the start of 4 years of being in and out of hospital receiving treatment (medication and ECT) for manic depression. Although there is a lot of bad press about ECT (electroconvulsive treatment), this was the watershed for me. A short course enabled me to start to recover and get to the point where I have been able to self-manage my mental health.

How did I manage my mental health?

I fortunately don't have deep bouts of depression, and by carefully managing my mood, I have avoided any subsequent breakdown. But I am very cautious. For example, if I sleep two bad nights, I usually do something to get a proper night's sleep. I am very aware I need to actively manage my workstyle and lifestyle so that I do not get into a state where I am completely out of control. However, I am not on any medication anymore, and I no longer have the fear of an imminent breakdown.

There are diverse ways of self-managing, and medication is often crucial. I would never recommend that somebody go against the advice of doctors to take psychiatric medication. Too many of my friends have died because they stopped taking their prescriptions. (Check out?https://mind.org.uk/for advice) For many of us, we can only make choices about our behaviour when medication brings us to a point where we can start to make those choices. But without the medication and ECT that I had, I would not have been able to make any changes to my behaviour. It allowed me to be in a position where I was able to reflect on what things improved my mental state and what things undermined my mental state. So, staying up all night working on an exciting idea is unsuitable. Not having regular mealtimes puts me at risk. More than one coffee in the morning can limit my ability to manage my emotions. Too much stimulation from other people or not enough stimulation from other people can undermine the balance of my mood.

An on-going process

I have come to a place where I can recognise when I'm on an 'up' and then make choices to reduce that impact and bring myself into a more orderly place rather than just enjoying the highs. Anyone with manic depression will say that the highs are wonderful. It's really exciting and great fun. Medication can dampen that feeling. I have found a way to self-manage so I can have the best of both worlds whilst being conscious, reflective, and prepared to listen to those around me. But I also accept that there may be a time when medication is necessary to restore the balance.

Responding to others

Kaur Lass notes from his experience of working with people that you must remember how to keep yourself well by respecting and self-managing your interactions with others. We can encounter anger, joy, frustration, annoyance, excitement and fear in our interactions. Learning to be aware and then self-manage these emotions is crucial. It's very easy to lose yourself to your thoughts and your feelings. Being aware of what is going on inside you gives you the power to stay calm and let go of problematic feelings that you are experiencing. You can listen and focus on what others say or hear your inner voice.

Is this age-related wisdom?

I was in my early 20s when I came out of this breakdown. I became extremely intentional about actively managing my mood. Over the years, I've improved and learned more about myself, but I think the crucial thing was my intent. I committed to making choices around what I eat, when I sleep, how much exercise I have, who I hang out with, and how much alcohol I do or don't consume. There have been times when I have been tempted to work all night, and there have been times when I have been tempted to go on great flights of fancy and have even more inspirational ideas. But I also notice that I can overdo it, and then I step back and make sure I do all the things that I know help me (being around people constructive to my mental health rather than destructive, eating well, sticking to sleep patterns, etc.).

Do you have to hit rock bottom first?

Kaur believes that one of the greatest misconceptions is that you must hit rock bottom to come out of the other side with the skills to manage your mental well-being. He blames the fact that, historically, we have had very little mental wellness education in schools, which means we don't have a toolset or a mindset for how to be mentally well.

Again, it's about intent and your inner decision to focus on things that keep you well. For Kaur, eats vegetarian food, tries to sleep well, takes long walks at the weekend, takes shorter walks every day, and doesn't watch much TV, seldom the news. If he watches movies or documentaries, he picks ones that are good for his mental health – but it must be something that gives him something. He believes strongly in the need to expose ourselves to more activities that keep us well and sees it as a lack of education that we are not doing this consciously very often. We sometimes happen to be in the right company or happen to take a walk somewhere, but how often do we have our action plan for staying well?

Mental Wellness Action Plan

For Kaur, a key is having an action plan, unique to the individual, of daily things to do. Things that keep them well. For example, starting each day with a moment of silence. If you have planned actions to keep yourself well, you can stay on the wellness side, and if you don't, then it's very probable that you will end up with (positive) stress, leading to burnout. You have to notice what is going on within your mind and be aware of the warning signs.

What is clear from this first part of the conversation between Jonathan, Kaur, and myself is that we all intentionally keep ourselves in a stable position and how much we use food, sleep and being with nature as part of our self-management.