Wednesday, 16 September 2020

Is Being "Too Sensitive" a Bad Thing?

No place for beginners or sensitive hearts
When sentiment is left to chance.

(Sade Adu and Raymond St. John. “Smooth Operator.”)

Have you ever wondered if you’re too sensitive or need to be more thick-skinned? Have others said it to you? The question came up recently in three separate conversations with friends and I’d like to explore it in some detail because it feels important.

I’m wary of labels like “too sensitive” or “too thin-skinned” because they imply there’s some universal scale of sensitivity and you’re outside the acceptable range. There may be some truth in that but careless use of such labels fosters stigma, including self-stigma when we use them about ourselves.

That said, my friends used words like these to describe what they’re going through. Setting my reservations aside, what did they mean?

What Does “Too Sensitive” Look and Feel like?

In their different ways my friends were expressing the belief that they respond to things in unhealthy ways, or to an unhealthy extent. This might manifest in many different ways.

  • Responding with frustration or anger if it seems people don’t understand what we mean or how things are for us.
  • Becoming anxious about what someone might do or say next time we see them.
  • Becoming irritated when friends don’t check in with us as much as we’d like them to, or when they want to connect with us all the time.
  • Feeling people are being judgmental or vindictive towards us.
  • Feeling hurt or distressed at things that don’t seem to upset other people as much as they do us.
  • Reacting in ways others find inappropriate or that seem disproportionate to what actually happened.
  • Feeling abandoned or pushed away when people ask for space or want to pay healthy attention to their boundaries.

In conversation it might sound like:

“My neighbour has his music really loud. It’s very distracting. I wish I weren’t so sensitive.”

“I need to be more thick-skinned then it wouldn’t hurt so much.”

“I worry too much and get offended easily. I take things too personally, like when my friend said what she said. I got mad rather than just acknowledging that I don’t agree.

Isn’t That Just Part of Everyday Life?

Up to a point, yes. Whatever our history or situation, we’ve all developed ways to deal with what life throws at us. Mostly we do a pretty good job of it. But sometimes our strategies don’t work as well as they usually do and we’re hit by something — or a series of somethings — that overwhelms our capacity to deal with it.

Maybe we’re overstressed or fatigued. Maybe we’ve not slept well for weeks or are dealing with chronic pain or a physical health condition. Maybe we live with a disability or a mental or behavioural health condition. Relationship problems or worries about friends and relatives, money, employment, housing... any of these can affect our ability to handle the twists and turns of everyday life. It’s worth remembering that what is “everyday” to one person might be difficult, traumatic, or triggering to someone else.

Whatever the circumstances, sometimes we find ourselves reacting in ways we normally wouldn’t, or shutting down because we can’t deal with everything all at once. That’s when we may need to look at how we’re doing and consider new strategies.

Is It Them or Me?

Given that we’re mostly talking about issues with other people, it’s valid to ask if the problem lies with their behaviour or our reactions to it. It can be hard to distinguish between banter, a difference of opinion, personality clash, bullying, harassment, and abuse — especially if our perception of what’s happening differs from the other person’s or from the opinion of other people involved. It’s important to trust our instincts, but that’s not always easy if we’ve come to doubt our ability to accurately gauge what’s going on — or if there’s someone telling us we’ve misread the situation or are overreacting.

Maybe we are — or maybe we are being subjected to gaslighting, which is a form of psychological abuse in which the victim is manipulated into doubting their sanity. The term comes from the 1944 film “Gaslight” in which Ingrid Bergman’s character Paula is almost convinced by her husband that she’s imagining things, when in fact he is scheming against her. Gaslighting can occur in any relationship, especially ones with an unequal power dynamic, including the workplace. It’s a strategy often adopted by narcissists to control and abuse their targets.

All that said, it’s important not to automatically blame the other person or assume they are trying to manipulate us. Most people aren’t out to trap, bully, or denigrate those around them. Most people are doing the best they can, often under circumstances we know little or nothing about. Fran has a phrase she likes to use: “Everyone gets to be who they are. Even the assholes.” It reminds me that we’re not responsible for (or able to change) other people, even those we find difficult or have issues with. On the other hand, we don’t have to excuse or condone behaviour that hurts us.

What Can I Do about It?

Our options depend on what’s happening.

Gaslighting or abuse

If you’re being subjected to gaslighting, intimidation, or any form of psychological, physical, or sexual abuse, consider seeking help. The NHS provides information and support links for the UK. Wikipedia has an equivalent listing of global resources. If it is happening in your workplace, there should be a reporting process for bullying or harrassment.

Physical and mental health

Being highly sensitive is not a diagnosis in itself but there are clinical conditions which encompass forms of emotional oversensitivity. These include borderline personality disorder, ADHD, bipolar disorder, major depression, and social anxiety. Physical health conditions including chronic pain, fatigue, and insomnia can also affect how we react. If you feel your issues might be health-related discuss your concerns with your doctor.

A friend of mine anticipated some difficult times ahead which might be hard for her to manage. Based on past experience she consulted her clinician to see if a change of medication might be appropriate. Fran and I keep an eye on how she responds to people and events because over sensitivity can be a red flag for mania or bipolar anger.

Give yourself space

If the problem is circumstantial and temporary you may find yourself less overwhelmed once the situation calms down. In the meantime, or if things keep triggering you, take yourself out of the situation if possible. A friend of mine does this if she finds herself overwhelmed or triggered. It can help to have someone you can safely let it out (or “vent”) to.

Meditation

Fran and I find meditation helps us respond more calmly and proportionately to whatever’s happening in our lives. Other friends of ours also find it useful. I recommend the loving-kindness meditation because it focuses on our attitude to other people. There are a number of versions, my favourite is this one by UNH Health and Wellness.

Resilience training, NVC, and the Four Agreements

You might benefit from learning some more healthy approaches to handling stress and situations that trigger you. If so, you’ll find a range of information and training available online for resilience training (for example here, here and here) and nonviolent communication (NVC). Also called compassionate communication, NVC is based on the idea that we all have the capacity for compassion and only resort to violent or harmful behaviour when we are unable to find more effective strategies to meet our needs.

With Nonviolent Communication (NVC) we learn to hear our own deeper needs and those of others. Through its emphasis on deep listening — to ourselves as well as others — NVC helps us discover the depth of our own compassion. This language reveals the awareness that all human beings are only trying to honor universal values and needs, every minute, every day.

Fran and I have found NVC helpful in exploring our responses to difficult situations with each other and with other people.

A friend recently mentioned something I’d heard of but knew very little about.

Have you seen The Four Agreements, Marty? One is: Don’t take anything personally. When other people say shit to me like that it’s a reflection of their ignorance and narrow mindedness. It really has nothing to do with me.

She was talking about a body of work inspired by The Four Agreements: Practical Guide to Personal Freedom, by Don Miguel Ruiz. The agreements are:

Be impeccable with your word.
Don’t take anything personally.
Don’t make assumptions.
Always do your best.

Of these, the second and third have the most to say about being (or feeling we are) too sensitive.

Don’t take anything personally. “Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering.”

Don’t make assumptions. “Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama. With just this one agreement, you can completely transform your life.”

Taken together with NVC, these principles remind us that other people have their issues, hangups, perspectives, and needs too. We don’t have to like how they behave towards us or others but we have options. Not leaping to conclusions, and not assuming we are at fault, can take us a long way towards responding in ways we feel comfortable about.

I’ll close with a quotation from a blog post I came across whilst researching this article:

If considering yourself as a ‘highly sensitive person’ (HSP) helps you understand yourself, and works to make your life easier and more fulfilled, wonderful. And if it means you focus your sensitivity in useful ways like being creative and empathetic, even better.

But if you find you are using being oversensitive as an excuse, then not so great. If you are opting out of relationships, for example, or not going after the career you want, because you are ‘too sensitive’, then that is not helpful.

And if you suspect you had childhood trauma or did not receive the love and care you needed when young, then it’s a very wise idea to reach out for support.

Do you consider yourself to be “too sensitive”? Do you consider it a blessing or a curse? Have you ever thought life might be easier if you were more thick-skinned? Do other people’s words and actions affect you more than is healthy for you? If so, what changes or strategies have you found helpful? We’d love to hear from you.

 

Photo by Nicole Baster on Unslpash.

 

Thursday, 10 September 2020

#WorldSuicidePreventionDay 2020

For #WorldSuicidePreventionDay 2020 we’ve compiled a selection of relevant articles we’ve shared over the past few years. Thanks to our friend and fellow mental health blogger Aimee Wilson of I’m NOT Disordered for the inspiration for this post, and much more.

How to Take Care of Yourself When Your Friend is Suicidal

Being in a relationship with someone who talks about wanting to die can be stressful and draining, so remember to pay as close attention to your well-being as to your friend’s. [Read more]

17 Online Suicide Awareness Courses and Podcasts

This article presents a selection of online suicide awareness courses and podcasts for anyone who wants to learn about this challenging subject that is a lived reality for many. No course or podcast can make you an expert overnight. You will, however, be better equipped to help someone who may be considering suicide and be in need of support. Many of these resources also address wider issues including stigma and the importance of open communication. [Read more]

The Stranger on the Bridge and Other Stories of Friendship and Support

Hearing Jonny talk about what happened on the bridge was intensely moving for me, as I’m sure it was for everyone in the room. He spoke of Neil holding space, of his being engaged and “invested.” Above all it was Neil’s positivity and lack of judgement that made the difference, as well as him telling Jonny there was no need to be embarrassed. This stranger’s acceptance, compassion, and simple humanity saved Jonny’s life. [Read more]

Sometimes We Need to Ask the Questions

This post was inspired by an open letter to me by fellow mental health blogger Aimee Wilson in response to an article I wrote recently about imposter syndrome, self-doubt, and legitimacy. In her letter, Aimee described how important it is to have people she can turn to for support. [Read more]

A Heap of "S" Words and an Aitch: Stigma, Suicide, Self-Harm - and Hope

Having a study buddy is great because — as Fran and I have found many times — you have someone to share ideas and perspectives with, and to talk through any issues that come up. This is especially valuable with something as complex and important as suicidality. [Read more]

She Is So Not OK: Being There When Your Friend Is Suicidal

Suicidal thinking has been part of our friendship since we met. Indeed, it is how we met. One evening in May 2011, I found myself on the social media page of someone who was clearly going through a rough time. She didn’t seem to be online, but in the previous hour she had publically shared suicidal thoughts and feelings. [Read more]

Dilemmas

Few people are helpful when you are sick and many push you closer to that edge, either from lack of understanding or by disappearing altogether. It is, after all, an illness, a dangerous one, as surely as any of the physical conditions that can take your life. It is hard to know, sometimes, where you end and where illness starts. Therein lies the conundrum. [Read more]

Be the Best Yourself You Can Be

I feel it is important to say that being there for someone who lives with suicidal thoughts and feelings isn’t all about talking them down from a bridge or asking how many pills they took, what they were and how long ago. [Read more]

 

If You Need Help

Our resources page includes links to suicide crisis lines / support organisations, training resources, and books. UK mental health charity Mind offers a range of help and information if you need support or are concerned for someone else.

 

Wednesday, 9 September 2020

No Sorries

Fran and I have a “no sorries” rule, which means that we don’t apologise to each other for things we do or say. There are times when we need to talk about things we know will be difficult for the other to hear, and we trust each other to handle what comes up.

This might seem strange. We are brought up believing we should apologise when we’ve done something which – deliberately or not – has upset or harmed another person. An apology, “Sorry I hurt you”, is how people generally acknowledge the damage they’ve caused and seek to set things straight. Refusing to do so might appear counterintuitive and disrespectful, as though we are refusing to take responsibility. In fact, the opposite is true. It’s far too easy to say “sorry” and expect the other person to move on, or demand an apology as though that will wipe the slate clean.

Don’t get me wrong, “sorry” has been known to escape our lips, although the other person tends to respond with a “no sorries” reminder and a smile, recognising that something important is happening. Because, of course, I do feel bad if something I say or do results in Fran feeling hurt or distressed, and she feels the same way.

Many years ago I reacted without thinking to Fran telling me she’d been drinking more heavily than usual. I leapt on her with the dangers of relying on alcohol to get her through difficult times, when what she needed was for me to listen. She wasn’t hiding her drinking from me, in fact she brought it to me precisely because she needed me to help her remain aware of what was happening. My instinctive response, however, was unhelpful and I realised so immediately.

Frannie, I know we don’t do “sorries”, but I am sorry for leaping at you like that!

It’s okay, Marty. No worries. No sorries.

I’m listening now. What were you trying to say?

The point isn’t whether or not we feel bad, it is how we deal with those feelings and what we take responsibility for. Fran and I take our personal responsibilities very seriously. If Fran says something which I find hard to accept or deal with, she will take responsibility for saying it, but I take ownership of my response.

Our triggered reactions are often only superficially related to what the other person said or did. It is my experience that there can be huge therapeutic value in triggered responses. More often than not I end up grateful to the other person for playing their part in the process.

“No sorries” does not mean that Fran and I get to blunder about with no awareness or regard for the other’s feelings or well-being. We do not deliberately trigger hurtful responses in each other for the fun of it or on the off chance that we benefit in some way as a result. But neither do we wrap each other in cotton wool, protecting them from experiencing things because we might judge it painful to them. That would be to rob both of us of the opportunity to learn something new about ourselves and each other.

In the first year of our friendship I wanted to buy Fran a gift for her birthday. She seemed to like the idea but as we discussed it one night she became increasingly distressed and anxious. I kept pressing her to talk about it. In the end Fran broke down in tears and ended the call. I felt awful and, as I recall, flooded her with apologetic messages and texts. I wanted to take it all back, to make everything right again, to erase whatever it was that had just happened. Later, Fran shared with me something of her life-long issues with gift giving and receiving. This helped me understand what had happened between us and offered me an insight into Fran’s past, her life and issues. I realised that hers were almost the inverse of my tendency to over-gift. If I’d been more cautious, if I’d spotted the early signs of her distress and backed down straight away we might never have reached that level of understanding.

More generally, “no sorries” gives us freedom to feel and express the little grievances, irritabilities and frustrations without feeling guilty for them, blaming the other person, or having to apologise afterwards. It doesn’t always work, of course, but it works more often than you might imagine.

So, the next time you find yourself about to apologise for something you’ve done or said, take a moment to consider what the “sorry” actually means to you. Find different words to express that meaning to the other person, and see what happens.

 

Photo by Tim Mossholder on Unsplash

 

Saturday, 5 September 2020

Let It Out! How to Vent Powerful Emotions Safely

Let it go, let it go.
Can't hold it back anymore.

(Kristen Anderson-Lopez and Robert Lopez. “Let It Go.”)

In a previous article I discussed three kinds of conversation you might encounter in a mutually caring relationship. I call these “My Turn, Your Turn,” “It Will Be Your Turn in a Minute,” and “I Need to Talk Right Now.” Each has its place but the third is arguably the most critical — and perilous — because we’re at our most vulnerable when we allow ourselves to share powerful emotions.

There are times when we want and need to just let the words flow, to “dump” (although I hate that expression), to express whatever it is we are feeling or thinking without being interrupted, questioned, or judged.

In this article I want to explore how to let the words flow — to vent — as safely and productively as possible.

Who, How, When, and Where

It goes without saying that it’s best to vent to someone you trust; someone who can hold space without judging you or trying to stem the flow of what you need to get out. Fran and I write about this kind of trust in our book High Tide, Low Tide:

We believe it is healthier to be open about our thoughts and feelings than to dismiss, hide, or avoid them. We share what is happening with us, discuss things if we need to, and then move on. In doing so, we hold a safe space where we can “let it all out.” We sometimes get upset or angry with each other, but we deal with discord promptly if it occurs, recognising there is no need to fear even powerful emotions when they can be explored safely.

It’s what Buddhist monk Thich Nhat Hanh has called deep listening:

Deep listening simply means listening with compassion. Even if the other person is full of wrong perceptions, discrimination, blaming, judging, and criticizing, you are still capable of sitting quietly and listening, without interrupting, without reacting. Because you know that if you can listen like that, the other person will feel enormous relief. You remember that you are listening with only one purpose in mind: to give the other person a chance to express themselves, because up until now no one has taken the time to listen.

Of course, not everyone wants or needs to vent in person like this. I find it hard to share really strong emotions, even with Fran and other friends I trust and feel safe with. I’m more likely to process strong emotions by writing them out. I’ve kept a daily journal for the past forty-five years and if I don’t have it with me I take notes on my phone. Venting onto the page like this helps me let things out without necessarily bringing them to others who might be affected by what I’m going through. Journaling does carry the risk of disclosure, however, unless you can be certain your words — whether digital or written in a diary or notebook — are secure from being read by others.

When words elude me, walking helps. It’s particularly effective when I’m in a rage or overwhelmed by feelings of abandonment, worry, or anxiety. It doesn’t matter much where I’m walking; what matters is the physical exertion and movement.

When I’m happy, I walk. When I’m sad, or lonely or lost. When I’m hurting, or numb. When there’s too much to think about Or nothing on my mind. I walk.

Walking is so important to me that I included it in my Wellness Recovery Action Plan (WRAP).

Be Clear About What’s Going On

If you’re opening up in person or someone is opening up to you, it’s important you both understand what’s going on. Clarity protects us from oversharing or overwhelm, or what BrenĂ© Brown calls floodlighting (not to be confused with gaslighting):

Oversharing? Not vulnerability; I call it floodlighting. ... A lot of times we share too much information as a way to protect us from vulnerability ...

Being clear about our needs gives the other person chance to make space and prepare themselves, or to say they’re unavailable if that’s the case. A close friend messaged me recently:

I could really do with a call. As soon as it is convenient for you if you don’t mind. I’m raging so will need to have the floor at first then it’s all yours!

I was grateful for the heads up. In those few words, my friend gave me the context and let me know how urgently my support was needed — as soon as possible but not necessarily immediately. I cleared space to take her call and was able to hold space from the start without engaging in small talk or asking unnecessary questions. On this occasion, I was aware of the back story but I try not to anticipate what — or why — someone needs to share with me. Fran rarely gives me a heads up but I’ve learned to let her lead when we start our calls in case there’s something she urgently needs to share.

As Long As It Takes

Anger is perhaps the emotion we most commonly need to vent, or that someone might need to vent to us, but it might be any strong emotion such as anxiety, frustration, resentment, despair, jealousy, or envy. Venting safely can form part of a protective strategy which allows us to acknowledge the emotion for what it is without acting in unhelpful or unhealthy ways.

Bipolar anger is a common experience for many who live with the disorder. One friend described it as “bipolar’s go-to emotion.” That might sound like abrogating responsibility, but I find the description helpful. It conveys how hard it can be to handle a triggered response and engage more “reasonably.” My friend takes herself out of the triggering situation if possible. Having someone to vent to — whether in person or on the phone — allows her to handle her anger safely until it has passed.

Holding space for someone in this way can take anything from a few minutes to an hour or so. While my friend is talking I try not to interrupt her, ask too many questions, or offer suggestions. After ten or twenty minutes the flush of anger has passed. She is calmer and can focus more clearly on what needs to happen next.

These days, it’s rare for Fran to vent anger in this way, although it’s happened in the past, particularly when she has been in mania. More usually, it’s frustration at her life situation or something that’s happened within her immediate circle of friends. Letting go might fill one or more of our twice-daily calls. Some deep-seated issues have seen me holding space for up to an hour or so every day for several weeks.

It’s similar when I’m venting to myself in my journal. I might “write it out” for half an hour or so at a time, then set it aside and return to it later if necessary. This might continue over a period of days or weeks if the situation keeps recurring.

Moving Forward

Venting can help us move safely through overwhelming emotion, but it is not a fix for whatever condition, situation, or trigger brought us to crisis in the first place. It might be a one-off, an occasional occurrence, or part of an ongoing pattern. If you’ve held space for someone, consider offering your support in the future. Knowing there’s someone who will listen no matter what you’re going through without judging you or insisting on “fixing things” can be extraordinarily reassuring.

Be the person who won’t turn away when your friend or loved one needs to vent. I’d go so far as to say it’s the single most powerful thing you can do to help someone deal with whatever they’re going through.

 

Photo by Jason Rosewell on Unsplash

 

Wednesday, 26 August 2020

Waiting for Fran: A Few Thoughts on Expectation and Boundaries

Originally written December 2012.

Last night I was waiting for Fran to get home and come online for our call. She messaged to say she was home and was just going to send her friend a birthday message. I was happy to hear that and figured she wouldn’t be long. Then she messaged to say she was going to check my Facebook wall.

I started getting impatient. Couldn’t she come on webcam with me while she did that? I put some gentle music on and did some meditative breathing while I waited.

Fran finally called at 11:30. She was thirty minutes “late”. The first thing she said was that she had found the “Two minutes of calm” video I’d posted on Facebook and had meditated to that. I was cross, because I’d thought we could have done that together (which we did, later, once I’d regained my composure).

Part of me recognised that, of course, Fran is free to do whatever she wants. She’d been out all day and must have wanted a little space to herself before meeting with me. But another part of me was sorely aggrieved. Surely she knew I was waiting and was eager to see her. It was a classic pouty moment!

It didn’t last very long. Fran was great with me. She allowed me to acknowledge what I was feeling until I was ready to let go of it. THAT is why we work so well together. We understand how these things work.

The day before, she was uptight about not having heard back from her friend about accommodation for their Barcelona trip. On that occasion I gave her space to express what she was feeling, to let it out so she was ready later to sort things out with her friend. It’s what we do.

Thinking about all that leads to something really important: the changes the well one goes through as the ill one moves towards wellness. The shifts in role. The sense of being abandoned or left behind; that all this care has been given and what is the caregiver going to get back in return? I remember Fran telling me of cases where the person with illness (cancer, I think) had really strong/bad reactions from their carers or partners as they moved towards wellness and the balance shifted.

It fits with what happened last night. I was frustrated because Fran didn’t seem as keen to be online with me as I was. In fact, she was taking care of herself and paying attention to what she needed, in a very healthy way.

I’m proud of her for doing that. I’m proud of us both.

 

Photo by Nordwood Themes on Unsplash.

Wednesday, 19 August 2020

Three Things I've Learned About Mental Health Medication

Following on from my article Three Things I Wish People Knew about Loving Someone with Mental Illness I want to share a few things I’ve learned about mental health medication. First, a disclaimer. I have no first-hand experience of taking mental health medication. What I’ve learned comes from my nine-year friendship with Fran and from other close friends.

My loved ones live with a variety of mental health conditions and symptoms including anxiety, bipolar disorder, borderline personality disorder (BPD), depression, visual and auditory hallucinations, suicidal thinking, and self-harm. Some live with more than one of these. Several also have physical health conditions to deal with, including chronic fatigue syndrome (CFS/ME), type 1 diabetes, fibromyalgia, hearing loss, visual impairment, and chronic obstructive pulmonary disease (COPD).

Despite their different conditions and histories, my friends have many experiences and approaches in common when it comes to medication. I’ve chosen three — compliance, weight gain, and vigilance — which seem particularly important from my perspective as a caring friend.

A Commitment to Compliance

Compliance (sometimes called adherence or capacitance) is the degree to which someone follows medical advice. It usually refers to medication (“taking your meds”) but it can apply to other things such as using medical devices, self-care, or attending and engaging with therapy. My friends all follow their prescribing clinicians’ instructions closely and rarely if ever miss a dose. If they do, it’s through a lapse of attention or because of a change in routine. Fran sometimes asks me to remind her about her meds when she is away from home, for example, and we double check she has all her medication before she travels.

My friends rightly consider themselves experts in their lives and how illness and medications affect them. They also respect the professionals involved in their care, although they may disagree with them at times. Fran has sought second opinions in the past, for example. As one friend said to me recently, “They’re the ones who have studied for years!” That respect comes easiest when the professionals — be they clinicians, psychiatrists, therapists, doctors, nurses, case managers, or other mental health workers — are open to the opinions, experiences, needs, and fears of those they are charged with supporting.

It took Fran many years to arrive at a set of meds which, by and large, allows her to maintain her stability without too many side effects. Some struggle to find that balance or are still on the road towards it. I can only imagine — and commend — the determination it takes to persevere, day after day, month after month with regimes of medication, often coupled with other treatments and therapies, with little success to show for it, whilst often enduring the most horrendous side effects.

I would never judge someone who is unable or unwilling to pursue a particular treatment regime if it proves unworkable or unendurable. Indeed, it should be part of their dialogue with their prescribing clinician. But the consistent message from those I know best is that a commitment to compliance is the straightest path to stability and wellness.

Weight Gain

Amongst the varied side effects of psychoactive medication, weight gain is one of the most common, least understood, and hardest to manage. In our book High Tide, Low Tide Fran and I discuss her struggles with weight, body image, and her relationship with food. Before we met I little understood how hard it can be to unpick the complex knot of interdependencies and make meaningful and lasting changes.

It’s a simple fact that many meds prescribed for mental health conditions lead to increased weight. The mechanisms are not fully understood but I don’t need to understand how it happens to know that it does. Fran and I have seen it with her weight over the years we have been friends. Almost every change in medication has led to a weight increase which has been incredibly hard to counter. I hear similar tales from other friends.

Weight gain is not a trivial or benign side effect. It can have serious physical repercussions and its effects on mood, self-esteem, confidence, and relationships cannot — and must not — be ignored. They can too readily lead to depression, despair, and suicidality. As one friend said to me recently:

My choice shouldn’t be sane and fat or skinny and fucking nuts. How many regular people would consider it and how many psychiatrists would put up with it? Being fat is a whole different stress emotionally and socially. It’s social suicide in many ways. Weight gain makes me very depressed. My mind is heavily weighed down by my thoughts as it is. When you add physical weight into the mix, everything feels heavier.

Ongoing Vigilance

Managing mental health conditions is a dynamic act akin to juggling, or keeping a set of dinner plates spinning. What balls or plates am I talking about? It depends on the person, their life experience, and underlying health conditions, but here are a few things Fran is juggling on a more or less constant basis:

  • Mental health (depression, mania, agitation, anxiety, suicidality).
  • Physical health (fatigue, pain, insomnia).
  • Activity, energy, and rest.
  • Weight, eating, and drinking.
  • Relationships (family and friends).

Each of these requires her attention and ongoing adjustments to keep everything from crashing to the ground. To hijack the familiar saying, the price of wellbeing is eternal vigilance.

Meds are meant to be stabilising but they often introduce new instabilities which themselves need to be managed. Even when things seem stable there is a need for vigilance. It’s the clinician’s responsibility to diagnose and prescribe but no one knows better than the person with illness what they need and are experiencing. For example, Fran can make temporary preapproved adjustments to her medication if she detects the onset of mania. If symptoms persist or worsen she will make an appointment to see her psychiatrist. Another friend recently experienced symptoms of anxiety for which she has been treated in the past. Recognising the dangers she consulted her prescribing clinician to ask if a meds adjustment might be appropriate.

A different friend’s pharmacy stopped dispensing one medication altogether. This wasn’t spotted for some weeks, during which my friend’s stability and safety were severely compromised. It was an error with potentially serious repercussions. Even after the mistake was corrected it took time to restore the full protective benefits of the medication. It’s fair to say my friend will pay very close attention from now on to what is dispensed. It’s also important to keep an eye on — and seek appropriate treatment for — physical symptoms such as insomnia, fatigue, and chronic or extreme pain because these can significantly affect a person’s mental health.

 

We’ve taken a look at some of the things I’ve learned about mental health medication. Do you have experiences you’d like to share? What would you want others to know? What is the most important thing you have learned? We’d love to hear from you.

Photo by Halacious on Unsplash