Wednesday, 25 May 2022

Here We Are Again: How to Support Your Friend When Their Symptoms Return

Being there for someone who lives with illness of any kind isn’t always easy, and it can be especially hard, for you and for them, when symptoms return after a period of relative wellness or stability. (I’ve written previously here and elsewhere about managing the contrary situation, where a friend or loved one is doing well.) This is something several of my friends experience. Despite differences in their diagnoses, certain common themes keep coming up.

It helps me to remember that no matter how hard or scary things might be for me when a friend’s symptoms return, it’s far worse for the person living with it day to day.

Return or Relapse?

Some people might call this a relapse. I prefer to talk about someone finding themselves in a similar situation as before, or their symptoms appearing to have returned. Neither Fran nor I are qualified to diagnose a new episode of mania or depression, for example. That’s her clinician’s role. What I can do is pay attention to how Fran presents when I’m with her and how she describes what’s going on for her. I can discuss things with her, and help her through it as best I can.

The word relapse has a number of meanings depending on context, some of which carry connotations of moral failure, weakness, or judgment. Alongside the straightforward description of relapse as “a recurrence of symptoms of a disease after a period of improvement,” Merriam Webster offers an alternate definition, as “the act or an instance of backsliding, worsening, or subsiding.” Collins online dictionary says “[i]f a sick person relapses, their health suddenly gets worse after it had been improving.” I have no issues with that, but they offer a more judgmental alternative: “If you say that someone relapses into a way of behaving that is undesirable, you mean that they start to behave in that way again.”

Ultimately, calling it a relapse or a return of symptoms is a matter of preference. Nevertheless, the words we choose matter. Avoiding any hint of judgment is respectful and kind, not least because our friends may well be feeling guilt or shame, imagining they’ve done something wrong, or not taken enough care of themselves to prevent their symptoms returning.

What Symptoms Are We Talking About?

Not all symptoms of illness recur, but many do. Time and again, we find ourselves “back here again,” experiencing things we thought — or hoped — we’d recovered from or left behind us. These will vary from person to person. Those my friends experience include anxiety, depression, fatigue, insomnia, mania, pain, psychosis, self-harm, and suicidal thinking.

The frequency and intensity with which symptoms return varies from person to person but also from symptom to symptom and over time. Sometimes, these waves of recurrent illness overlap and exacerbate one another, as Fran describes in our book:

[it’s] amazing how i can be doing well for a while and then deteriorate so quickly for no apparent reason other than i have three illness that have a mind of their own and independently operate like sine waves..

Why Do They Keep Coming Back?

Understanding that there’s no simple or single reason for symptoms to come back helps counter the tendency to blame ourselves or our friends when they reappear.

Some conditions are inherently episodic or cyclical, such as bipolar disorder, seasonal affective disorder (SAD), or the stress and anxiety many people experience around family holidays such as Christmas or Thanksgiving. For many years, Fran experienced winter depression. She loves the potential offered by the summer months but finds the transition from spring to summer hard.

Some are situational, such as stress or anxiety related to work pressure; personal issues with family, friends, or colleagues; or other aspects of our lives and environment. We may be free of symptoms for long periods, only to have them return when the situations which trigger them present themselves again.

Symptoms may reappear as the result of changes in medication or treatment regimes, including starting or stopping a particular medication, or changing dosage. My friend and fellow mental health blogger Aimee Wilson has written about her experiences after one of her medications was inadvertently stopped by her pharmacist. Another friend experienced what appeared to be a moderately severe episode of depression. Her psychiatrist identified it as a side-effect of medication prescribed by a different doctor for an unrelated condition.

With some conditions, symptoms may return even after long periods of remission. Examples include cancer; pain from previous injury or conditions such as fibromyalgia; and fatigue, including chronic fatigue syndrome (CFS/ME). Other recurrences are random, or effectively so. These include symptoms triggered by factors outside our control or ability to anticipate or avoid. Such triggers include trauma, injury, sudden change, and the death of a family member, friend, or pet.

It’s worth noting that symptoms can arise in different ways at different times, even for the same person. In High Tide Low Tide: The Caring Friend’s Guide to Bipolar Disorder, Fran and I discuss several ways suicidal thinking presents itself for her, including relentless thinking, suicidal ideation triggered by situations and stress, and feelings of hopelessness and despair.

How Does it Feel?

Whatever their cause, nature, and intensity, when symptoms reappear it’s natural to feel low, frustrated, guilty, and even angry at being “back here again” despite all best efforts to keep ourselves safe, stable, and well.

I’m more used to helping friends handle these feelings than dealing with them myself. That said, in the past year or so I’ve had to accept that my baseline mood has shifted significantly downward, and I’m subject to recurring episodes of what I variously describe as flatness, low mood, or depression. In other words, this boy gets sad too. It’s not only my mental health. I’m currently experiencing intermittent fatigue after contracting covid a couple of months ago. It’s too early to know if this is going to persist, but it’s disconcerting to think it’s something I may need to factor into my life. The conversations I’ve had with Fran and other friends over the years about their situations are helping me feel my way forward.

What’s the Best Way to Help?

What’s the best way to help your friend handle the return of their symptoms after a period of relative wellness? The first thing I’d suggest is to encourage your friend to acknowledge what they’re feeling, whether that’s disappointment, frustration, anger, or hopelessness. Hold space for them to vent or talk about their feelings, if they want to. Acknowledge your feelings too, but avoid bringing judgment into the space you’re sharing with your friend.

Invite your friend to accept the unpleasant truth that recovery isn’t always guaranteed, may not be linear, and is often temporary. I use the word invite deliberately, because this isn’t an easy thing to accept. Fran lives with three episodic conditions — bipolar disorder, chronic fatigue syndrome (CFS/ME), and fibromyalgia. When she’s relatively well and stable, it’s hard for her — and for me — to accept that depression, mania, fatigue, and pain are almost guaranteed to reappear at some point. The only up-side I can offer when they do is that it’s equally certain the episode will not last forever. Things will change, because they always do.

It’s also true that no matter how much your friend may feel they’re “back here again,” things are not the same as on previous occasions. Their situation in life is different (not always better, but different). They have moved on from where they were last time. They have whatever lessons they’ve learned from previous episodes to help them through this one.

Our friend Julie A. Fast, author of books including Getting It Done When You’re Depressed, Take Charge of Bipolar Disorder, and Loving Someone With Bipolar Disorder, stresses the importance of treating the underlying health condition. Her mantra TREAT BIPOLAR FIRST is a reminder not to give up on whatever treatments, practices, and strategies we’ve put in place, including self-care. That doesn’t mean blindly following previous regimes if they’re no longer working. Where symptoms continue to reoccur or episodes increase in frequency or severity suggest your friend consults their clinician to see if a change in treatment is warranted.

Your friend may be reluctant to do so, especially if they’ve managed to achieve a degree of stability, because as we’ve discussed, changes in treatment can introduce new problems. These include side effects of the medication itself, and the potential to overshoot if the dose isn’t judged correctly. Fran experienced a massive overshoot from mania into depression when her medication was changed towards the end of 2011. She endured six months of debilitating depression before further changes in treatment brought a degree of stability and wellness.

Another friend who lives with bipolar disorder and chronic insomnia has had various changes to her treatment regime in the time I’ve known her. Despite often feeling frustrated and discouraged, she remains determined to explore her options in pursuit of mood stability and more healthy sleep patterns. As I remind her, this determination not to give up, and to keep moving forward is what courage looks like.

I help Fran remain vigilant for the return of symptoms, and potential trigger situations. It requires a high degree of trust and honesty. I get to share what I see in terms of Fran’s behaviour and flag any potential shifts into depression or mania to her, but it’s important not to overreact, and that I respect her take on what’s happening. That way, we each benefit from the other’s perspective. Fran gets to have a bad day (or several consecutive bad days) without it necessarily signifying she’s in depression. Likewise, she’s entitled to feel good without me raising the mania flag at the first sign of happiness. As I’ve written elsewhere:

We are both aware of the need for vigilance. Bipolar is like that. Any brightness, any momentary joy, each lifting of the curtain, is suspect, and may be the prelude to mania. But as I told Fran today: “You are doing well, and it feels wholesome to me. We will be vigilant. But don’t be scared to have a nice time, to smile, to find ease and enjoyment. These things are your right. You are worthy of them; of goodness, of living life fully.”

Sharing the responsibility for vigilance isn’t for everyone. I’ve offered to do the same for other friends and had my offer politely declined as unnecessary or inappropriate. That’s okay too.

A Final Note on Judgment and Kindness

I had a conversation recently with a friend about self-harm. My friend hasn’t self-harmed for a long time and cannot imagine herself being in that place again. Nevertheless, she said she’d never say it will never happen, only that she has developed more healthy coping strategies. I said I would never say that she — or anyone — had let themselves or me down if they self-harmed, no matter how long it had been since they last did. It wasn’t a throwaway comment on my part. It’s something I believe and know to be true.

Don’t get me wrong. I’m not immune to feelings of disappointment and judgment, but I recognise they’re profoundly unhelpful and say more about me than the person I’m thinking about. Whatever the situation, whether it’s the return of symptoms or the repeat of unhealthy behaviour, what is helpful, what is kind, is to allow my friends and loved ones to be where they are, including feeling ashamed or disappointed in themselves if that’s what they’re experiencing. That way I can be there for and with them, and help them find a way forward when they’re ready to take that step. Taking time to come to terms with what’s happening is an important part of that process. As I’ve described previously in a piece titled I Wasn’t Disappointed in You When:

I wasn’t disappointed in you. But maybe you were. And I didn’t honour that. I didn’t allow breathing space for that.

Over to You

In this article I’ve shared some of the ways I am there for my friends when they’re experiencing symptoms of illness again after a short or a long period of relative wellness. How do you feel about what I’ve shared? Does it resonate for you, or would you handle things differently? If you experience recurrent symptoms yourself, how do you handle it? What do you want and need from your friends and loved ones? How can others best help you move forward?

Fran and I would love to hear your thoughts, either in the comments below or through our contact page.


Photo by LinkedIn Sales Solutions at Unsplash.


Wednesday, 18 May 2022

Up-Blips of Emotion: Exploring the Strange Things That Make My Weird Little Heart Happy

There’s a joke in my family when talking about treating oneself to something: “You’ve got to have some pleasure in life!” The required response, of course, is “You don’t have enough pleasure already?!” I was thinking about this the other day after posting my piece on loneliness for Mental Health Awareness Week. In the article I explored Mark Rowland’s notion that we feel lonely when there’s a mismatch between the connections we have and our social needs and wants. If that’s true, I wondered, what about our other needs? What do we feel when those go unmet? Sad? Angry? Frustrated? Empty? Unhappy?

More generally, why do we find some activities and experiences pleasurable and not others? Why do we yearn for happiness and pleasure? What does it mean to be happy, anyway? What about all the times we’re not happy? Do they have value too, or are they merely to be lived though until our next fix of happiness? What’s the point of being happy if you’re only going to be not-happy again afterwards? I was tangled up in these thoughts when I came across a quotation by American journalist and author Elizabeth Gilbert.

Don’t ever be ashamed of loving the strange things that make your weird little heart happy.

It brought a smile to my face, not least because I’m almost certainly overthinking things! I’m not sure pleasure and happiness are meant to be rationalised to this extent. Analysing — over-analysing — is something I do, and on the whole I’m okay with that. But it can be good to just let things happen without trying to figure them out logically. I shared the Elizabeth Gilbert quotation with my friend Brynn. We agreed there’s a lot of social pressure to be happy, or at least to present as being happy, despite the fact it’s not possible to be happy all the time. She observed that connecting with people seems to make me happy. I didn’t disagree, although I wasn't sure it was quite the right word for how good connections make me feel.

What else makes you happy, Marty?

I thought a moment before answering.

Hmmm. I’m not sure. I don’t know that I’m “happy” very often. I don’t mean I’m flat or low all the time, although I do get that way sometimes. I’d mostly describe my good times as feeling positive or engaged, rather than “happy.”

So you don’t consider yourself a happy person?


I know how you feel. I have moments of happiness but in general I’m not a happy person either.

I don’t see it as a negative thing or an issue.

Me neither. It is what it is.

Happiness is just a word and different people will use it in different ways. What I call being positive or engaged, someone else might call happiness. Semantics aside, I’ve always been suspicious of the need to be happy because to me it’s a fleeting, or at least a temporary, state. I’ve enjoyed many moments of happiness, but the longer term has always seemed more important to me. For much of my life that long-term state has been wholesome and positive. Maybe that’s why I’ve not felt the need to pursue those up-blips of emotion called happiness: if and when they came along, it was a bonus. The icing on the cake. That all changed last year, when I became aware of a significant downward shift in my baseline mood.

I’ve always believed my emotional and mental health baseline to be essentially positive and healthy. Things might happen at times to upset my equilibrium, but after a shorter or longer period I return to my place of stability and wholeness. Lately, though, this model has been turned on its head. Instead of events and situations disturbing me from an essentially healthy baseline, it feels as though my baseline itself has shifted downwards. Positive events and situations such as meeting up with a friend, or feedback on one of my blog posts [...] can lift me up, lighten my mood, or provide an alternative focus for a while. But, once the distraction has passed, I’m pulled back to this low mood baseline.

Things that used to bring me pleasure seem less worth pursuing now. What’s the point, I find myself asking, when I’ll return to that lower mood afterwards? I used to take myself into Newcastle City centre almost every Saturday. I’d visit my then favourite coffee shop for an hour or so, then wander round the shops, calling in at the art gallery or museum, or perhaps venture down to the quayside. I stopped doing all that due to covid, but even though restrictions have lifted, I’ve felt little urge to return. I’ve been into Newcastle twice this year to meet up with friends, but have had no interest in exploring on my own as I used to.

Instead, I spend Saturday mornings in my local Costa coffee shop, writing, then head home for the rest of the day. There’s nothing wrong with changing my habits and patterns, and I look forward to “coffee and scribbles” at Costa. It’s become the highlight of my week. My “happy place.” What’s arguably unhealthy is that I have little to no desire to explore or plan other things. That “what’s the point?” is not a good sign.

What is the point, though? It sometimes feels as though “doing happy things” is little more than a distraction from however else I’m feeling or whatever else is going on for me. This is something I’ve discussed many times in conversations with Fran and other friends. If we’re feeling low, sad, or depresed; if we’re going through hard times of any description, why wouldn’t we want to distract ourselves or escape into moments of happiness — whatever happy might mean to us. I’m reminded of the words of author J. R. R. Tolkien, in response to the accusation that literary fantasy (which he refers to as fairy-stories) is an escape from reality.

I have claimed that Escape is one of the main functions of fairy-stories, and since I do not disapprove of them, it is plain that I do not accept the tone of scorn or pity with which “Escape” is now so often used [...] Why should a man be scorned if, finding himself in prison, he tries to get out and go home? Or if, when he cannot do so, he thinks and talks about other topics than jailers and prison-walls? The world outside has not become less real because the prisoner cannot see it. In using escape in this way the critics have chosen the wrong word, and, what is more, they are confusing, not always by sincere error, the Escape of the Prisoner with the Flight of the Deserter. (J. R. R. Tolkien, On Fairy Stories)

Thinking about it in this way, maybe the point of happiness is precisely to provide temporary relief or escape from whatever else is going on for us. Both Tolkien and Gilbert suggest there’s nothing weak or shameful in this. I needn’t worry, then, that doing things that bring me pleasure provides only temporary distraction.

That word temporary is important. Happiness can take us out of our present situation for a while and allow us to recharge our physical, mental, and emotional batteries. I’ve shared some of my distraction techniques previously, in posts such as Ten Ways to Turn a Bad Day Around, Nine Ways I Distract Myself When I'm Feeling Down, and Notes for a Happy Life. However, it’s not — and must not become — an excuse or strategy to ignore or avoid our problems.

Elizabeth Gilbert choice of words — her strange things and weird little heart — reminds us that happiness is intensely individual. The things that lift my heart may be very different to the things that lift yours. And that’s okay. So, what strange things make my weird little heart happy? Let’s start with some things I enjoy doing.

  • Writing on good quality paper with a fountain pen with an extra fine nib.
  • Sending my friends a good morning message.
  • Setting out my writing station — phone and tablet on their little stands, keyboard, notebooks and pens — in my local coffee shop as I settle in for some quality me time.
  • Working creatively in my Traveler’s Notebook.
  • Completing the draft version of whatever blog post I’m working on.

Those all bring me pleasure, but I wouldn’t say they make me happy. They’re things I can consciously choose or decide to do. My happy moments are far fewer in number and much less frequent. They are also unplanned. Unpredictability is an important aspect of true happiness for me. To misappropriate the words of Tolkien’s Oxford contemporary C. S. Lewis, happiness for me means being surprised by joy. Unexpected feedback on my blog posts or books, especially where it’s clear they’ve had a significant impact on the reader; news of a friend’s achievements or success; unanticipated hugs; crowd karaoke — these are a few of my favourite happy things. (That last one is a few year’s old now, but it’s still the first thing I think of when I think of happy!)

Where does all this this bring me? If true happiness isn’t something I can plan for or anticipate, maybe the best I can do is hold myself open to its appearance and appreciate it when it occurs. More practically, I can build more opportunities for pleasure and meaning in my life, and embrace “distractions” without feeling as though they’re a waste of time, focus, and energy. What’s the point? may be the ultimate unanswerable question, but maybe asking it is answer enough.

After all, you’ve got to have some pleasure in life, right?

Over to You

I’ve shared a few thoughts and ideas about happiness, but what does it mean to you? What makes you happy? Would you call yourself a happy person? If not, do you wish you were? When was the last time you were truly happy? We’d love to hear from you, either in the comments below or via our contact page.

If you’re interested in further musings on the Elizabeth Gilbert quotation, check out this post by Ella at LaWhimsy.


Photo by Stan B at Unsplash.


Wednesday, 11 May 2022

It's Not Enough: Exploring Loneliness for Mental Health Awareness Week

Loneliness is the feeling we experience when there is a mismatch between the social connections we have and those that we need or want.

— Mark Rowland, CEO, Mental Health Foundation

I’m grateful to my friend and fellow mental health blogger Aimee Wilson of I’m NOT Disordered for inspiring this post.

The theme for this year’s Mental Health Awareness Week is loneliness. I can’t always draw on my lived experience when discussing mental health, but loneliness is something I know first-hand. I think that’s true of everyone. We’ve all been lonely at some time in our lives, and yet each of us experiences it in our own way.

Perspectives of Loneliness

Keen to elicit some different perspectives, I posted a request on social media for contributions on the theme of “what does loneliness mean to me?” I received some brilliant and heart-moving responses.

“Loneliness is feeling like no one in the world could possibly understand you or what you’ve been through.” (Aimee)

“Loneliness doesn’t have to mean alone. You can feel lonely in a room full of people.” (Vikki)

“Loneliness is like a mental and emotional prison sentence where you are restrained and gagged. Each day they get tighter, never knowing when you will be freed or rescued.” (Emma)

“Being awake feeding the baby, walking up and down for hours feeling it’s just you alone in the night.” (Melanie)

“It means an absence of true support, and feeling unconnected to people who you are surrounded by.” (Brynn)

“A feeling of emptiness and nobody is there.” (Christine)

“That it’s possible to feel so alone despite being in a roomful of people. Feeling disconnected to everyone around you.” (Louise)

“Alone is different than lonely. Alone, I’m an intrepid adventurer, camera in hand, prowling through sun dappled woods, seeking a hidden waterfall; excitedly content when I find it. Lonely, I’m sitting, knitting, staring blankly ahead, trying to empty my mind … my hands not actually moving at all.” (Bernadette)

“What if you don’t ever get lonely? I prefer to be alone, it frustrates me when people think it would ‘do me good’ to get out and socialise more. The opposite is true.” (Cal)

“Loneliness to me means isolation, inability to connect and pain.” (Veronica)

“I have not experienced much loneliness in my life. I enjoy quality alone time. But it is good to see old friends every now and then.” (K. J.)

“I’m pretty much homebound now. Luckily, I like my own company and have a dog. There are times though that I just cry, I don’t know why, I just do. Until my second stroke and a TBI [traumatic brain injury] I’d spend days in the woods, by myself, the emotional and spiritual pain of that makes me cry too.” (Erik)

“You can feel loneliness when you are around friends and family and you are ignored even though you are starving to be part of the group. I feel that a lot, unfortunately.” (Patricia)

I’m grateful to all who shared their thoughts and feelings on this most personal of topics. I relate to some of these comments strongly, especially the last one with its sense of feeling excluded when all you want is to belong. That’s a loneliness I know well and have written about before.

Loneliness as Unmet Needs

I have a family. I have friends and colleagues, including a number of very close friends who comprise my support network. I nevertheless feel profoundly alone at times. This can be hard to accept or admit, even to myself. How can I be lonely when there are so many people in my life? I found an important insight in the words of Mental Health Foundation CEO Mark Rowland (emphasis is the author’s).

Loneliness is not about the number of friends we have, the time we spend on our own or something that happens when we reach a certain age. Loneliness is the feeling we experience when there is a mismatch between the social connections we have and those that we need or want. That means it can be different for all of us.

This makes a lot of sense to me. Our connections can be many, strong, real, and meaningful. Yet if they’re not meeting our needs, individually or collectively, we can still feel very much alone. One particularly perceptive friend told me a while ago: “a lot of your sense of self and wellbeing relies on contact with others. This can be both a good and a bad thing depending on when and what and how balanced it is.” Another friend said of someone she knows, “I care about her but there again, I feel lonely in that friendship because I can’t just be myself.”

What Loneliness Means to Me

My earliest memory of loneliness goes back to my first year at university. I would stand night after night at the window of my halls of residence looking out across the lights of the city, extravagantly empty and alone. I ached for something I had yet to experience. Genuine connection. There's a Genesis track I remember from those days. It contains the lines, “It’s not enough, it’s not enough. This feeling I’m feeling inside. Oh, I know it, I know tonight that I’ll be on my own again.” Forty years on, that track (Alone Tonight) can bring me to tears. Ironically, back then, I would not have cried. I had yet to learn how.

One Friday in September 1982, I arrived in Norwich to begin a six-month work placement at the regional hospital. I unpacked in my tiny room in the nurses’ home, and phoned friends to let them know I’d arrived safely. I enjoyed the months I worked there, but on that first night as I put down the phone, with the weekend ahead of me in a new city with no one I knew, I felt an almost existential loneliness.

A year later, I left university to begin a research post in London. I felt empty, hurt, and very alone. Much of the pain was of my making, the product of emotional immaturity and a self-centredness I cringe to recall. Years later, a close friend died, and I realised that due largely to my complacency I’d lost touch with the people I’d previously relied on to be there for me. As I’ve described elsewhere, “I had my immediate family — and pretty much no one else. I had never felt more alone.” It proved a turning point, however, and led to some significant changes in my attitudes and expectations which served me well.

Not that everything was plain sailing from then on. A dozen years ago or so, a friendship ended chaotically, triggering an intensity of loss and emptiness I’d never experienced before. In that moment I learned how to cry. It feels wrong to say, “so at least something good came of it,” because the other person was hurt in the process. It was, nevertheless, another seminal moment.

Move forward a few more years. Another friendship and another break-up. This time, it involved far more than the loss of someone dear to me. Much of what I thought I’d learned about myself, and most of what seemed positive about my life, was thrown into question. I’ll never pretend it was easy because it wasn’t, but I worked hard to understand what had happened and my role in that. My friend and I eventually reconnected. That was a new and valuable experience in itself. Until then, broken connections and lost friendships had rarely been taken up again.

Addressing the Imbalance

It’s clear from what I’ve just written that connection is very important to me. It’s one of my key life values, the others being challenge and creativity. Not everyone is like me in that regard, but whether we value many connections or just a few, if our emotional needs are not being met it’s worth looking at both sides of the equation: our connections and our expectations.

What does this kind of exploration look like? It will be different for everyone, but I’ll share some of my recent thinking. A few weeks ago, I decided to read a couple of my old diaries; something I rarely do. More or less at random, I picked 1982 and 1983. Revisiting my former self in this way was an intense experience. Then as now, people were very important to me. My diary entries are filled with my interactions with friends, colleagues, and fellow students. My mood and sense of self were governed by my connections with all these people. It was something of a shock to realise that in some ways, not much has changed. I’m better at handling the ups and downs, but I still place a high value on my connections. I still get excited if someone new enters my life. It still hurts if a friend or friendship is struggling.

The main insight I gained, however, was that it’s unnecessary and unrealistic to expect one set of people to meet our needs for all time. Hardly anyone from the early eighties is active in my life today, and none of the most important people in my life now were around back then. Some of my closest friends weren’t even born in 1983! People come and go. That might sound sad — or obvious — but there's an upside. I might be lonely right now but there’s every reason to believe there are more amazing people out there, just waiting to enter my life. As writer Iain Thomas puts it, “Someone you haven’t even met yet is wondering what it’d be like to know someone like you.” This hope can be difficult to hold on to. If you’ve lived in the same town or worked the same job for years without finding the connections you crave, or have lost the ones you had, it can be hard to believe new people are out there. And if they are, how do you find them? It’s easy to say “join a club – or go to the gym” but if these aren’t your thing (they’re not mine!) what do you do?

Instead of focusing on the connections you don’t have, think about those you’ve achieved in the past. If you did it before you can do it again. How did you meet? What drew you together? I met most of my current close friends online, including Fran who I connected with on a mutual friend’s social media page in 2011. I met my two local best friends volunteering for the mental health charity Time to Change, and made other connections through local groups and events. Time to Change closed in March 2021, but I could volunteer elsewhere. Some of the groups I attended are no longer active or open to me, but there will be others to explore — not explicitly to meet new people, but it would open that up as a possibility.

When we’re lonely, it’s easy to think we’re doing something wrong. We imagine we’re putting people off, not trying hard enough, or sabotaging our relationships. It doesn’t help to blame ourselves, but it’s healthy to explore how we connect and interact with others, to see if there’s anything we might wish to change. Look for patterns. Do you tend to connect with people who are not a good fit for you? Do you behave in certain ways that seem to push people away? These are all things we can explore and change.

I’ve always tended to be “too much” for my own good. Too attentive. Too generous with my time, energy, and affection. My timeline is scattered with people I’ve overwhelmed, upset, or pushed away by being unnecessarily intense and overbearing. I’ve come a long way in addressing these tendencies, but it’s something I still need to guard against. I’m grateful for the people in my life who accept this about me whilst also challenging it when necessary. Codependency is a related toxic trait which Fran and I are particularly vigilant about in our friendship.

Reconciling the connections we have with what we want and need doesn’t mean giving up on our expectations or “making do” with unsatisfactory situations. It does mean exploring our needs and adjusting them where they’re unrealistic, unhelpful, or unhealthy. It isn’t easy but it does work. One of the most valuable things you can learn is who you are, separate from your connections. There are behaviours and expectations I used to have, that I’ve let go of or adapted. There are some I still need to address. But there’s some needs I’m content with. Whether they’re met or unmet at any particular moment, they’re a fundamental part of who I am. Lonely or not, I am enough.

Further Reading and Resources

Founded twenty-one years ago by the Mental Health Foundation, Mental Health Awareness Week is an annual event focused on achieving good mental health. Check out the Mental Health Foundation website for further information, ideas, and resources, including a loneliness pack for schools and a student guide to loneliness.

For help with the loneliness of bereavement visit Cruse Bereavement Support or the bereavement resources page provided by UK mental health charity Mind.

Whatever its source, chronic or extreme loneliness can become profoundly unhealthy and debilitating. This article by Mind offers practical tips to help manage feelings of loneliness, and other places you can go for support. The Mental Health Foundation also shares tips and advice on coping with feelings of loneliness and isolation.

You will find links to support organisations and crisis lines on our resources page, and in this roundup of resources for men’s mental health.

Over to You

I’ve explored what loneliness means to me and shared insights from others on this important topic. How do you feel about what you’ve read here? What does loneliness mean to you? Do you get lonely? How do you handle loneliness and what impact has it had on your life? Please feel free to leave a comment below, or contact us.


Photo by Sasha Freemind on Unsplash.


Wednesday, 27 April 2022

10 Ways to Spend Quality Time with Your Friend That Don't Involve Talking about Mental Health

Most of the posts Fran and I share here at Gum on My Shoe are about mental health, which is one of the core themes of our blog. The other theme is mutually supportive friendship. Being able to talk with your friend about their mental health and yours is foundational, but it’s just as important to spend time together that isn’t focused on whatever you might be going through at the time.

Sharing quality time reinforces your friendship, builds memories, and reminds you both that you value each other’s company in fine weather as well as in stormy times. Plus, of course, it’s just really good fun! Here in no particular order are ten ways I enjoy spending time with Fran and other friends.

1. Read to Each Other

We don’t do it as much as we used to, but Fran and I love reading together. More accurately, we love me reading aloud to Fran on our video calls. Our reading list has included fiction and non-fiction titles, including the McCabe and Savage series of thrillers by Maine author James Hayman, Donna Tartt’s The Goldfinch, and Outlander by Diana Gabaldon. The last book we read together was The Isolation Artist by award-winning arts writer Bob Keyes, about the life and death of American artist Robert Indiana.

Whatever the subject matter — I’ve read short stories, blog posts, and news articles to Fran as well as the longer books and series — there’s something very cosy and intimate about reading aloud to someone, or being read to. Give it a go sometime!

2. Do Something Creative Together

Despite living three thousand miles apart, Fran and I have written two books together. Maybe writing isn’t your thing, but if you and your friend share creative interests, getting together to discuss or work on your projects can be a very satisfying way to cement your friendship.

My friend Aimee blogs at I’m Not Disordered, and our mutual interest in blogging is an important aspect of our friendship. Whether we’re struggling with ideas, planning a new article or collaboration, asking for advice, or simply sharing what we’re working on at the moment, it means a lot to have someone who understands what we’re trying to accomplish. We also share an interest in creative journaling and scrapbooking, and sometimes get together to work on our current projects, whatever they might be.

3. Watch TV Shows and Movies

This might seem too obvious to include. Don’t friends do this anyway, whether they have mental health issues or not? Perhaps, but as with many of the activities I’m suggesting, it’s easy to overlook the value of “chill out time” spend with a friend. This might include going to the cinema together if your friend lives locally, but it’s easy enough to share screen time online.

Fran and I meet pretty much every day to watch movies or TV series together. We open a Skype call with me on my PC or tablet and Fran on her laptop. She brings up Netflix on her TV and turns the laptop so I’m facing the screen and can watch along with her. We’ve watched many different movies and series like this, as well as sporting events such as the Superbowl and Triple Crown horse races.

My friend Jen also lives in the US, and we’ve met online a few times to watch her favourite TV show, Northern Exposure. She gifted me the first season on DVD and I played it on my PC, sharing the screen with her on our video call. It was lovely to be able to share something that means so much to her. I rarely go to the cinema but I enjoy visiting Aimee for movies and takeout. “Netflix and pizza” has become synonymous for quality time together and is something we both look forward to.

4. Go For a Picnic

Not everyone might agree but in my book it’s hard to beat going for a picnic with a friend! Aimee and I planned a picnic day in Morpeth a few years ago, which was a great success. We also picnicked in Aimee’s garden in April 2021 as England emerged from lockdown; you could meet up with people again as long as it wasn’t indoors.

Picnics are arguably harder to arrange if you don’t live locally. I don’t recall Fran and I sharing a picnic virtually, but we’ve arranged video calls to share a drink many times, in our respective homes or when out and about. One occasion I remember with great affection was a video call with Fran and her friend Tracy. I was in the beer garden of a lovely pub in Ambleside in the English Lake District while they were having a drink at the Monhegan Brewing Company on Monhegan Island in Maine. It was a lot of fun, made all the more hilarious by the various video filters we played around with!

5. Plan a Trip

Fran loves traveling and over the years I’ve accompanied her virtually on trips all over the world. A big part of my travel buddy role is helping Fran plan for her excursions. Amongst other things, this involves looking for flights and accommodation, things to do when she gets where she’s going, or working with her on her packing lists. On a smaller scale, I love planning local days out with friends, whether that’s day trips with Aimee to Edinburgh and Durham as we did last year, or drives out for lunch with my friend Vikki. The latter are a real treat for me as I don’t own a car, so I get to go places I wouldn’t otherwise be able to visit easily.

Planning time to celebrate birthdays, the anniversary of your first meeting as friends, your successes and achievements, or other special occasions counts too. It doesn’t need to be big or expensive: a simple meet up for coffee or a drink reminds you both that you value the pleasure of each other’s company. Some of my fondest memories with friends have been when we’ve met to mark our respective birthdays and successes, such as Aimee’s blog achievements or Vikki’s return to university a few years ago.

6. Have a Music Night

It’s great to share music with friends, whether virtually or in person. Jen and I love sharing songs when we’re online together, taking turns to suggest our favourite tracks and artists. Even when I’m listening to music on my own, I often post YouTube links to my Facebook page so other friends can listen along if they choose to. It’s a great way to connect with other people with similar (or indeed widely different) musical tastes.

It’s been a long time since I attended a live gig or concert, but I have great memories of listening to music — and singing and dancing along! — at Stack Newcastle with Vikki, and open mic nights at Bar Loco. I’m sad that Stack is about to close, but I will be keeping an eye — and an ear — out for other live music venues.

7. Take a Walk Together

As I’ve written previously, walking has always been an important part of my life. Even when I’m walking on my own, I love to share the experience with friends. This was especially valuable during lockdown, when I shared my daily walks for exercise with Fran and other friends via voice or video calls. Whether it was cows or horses in the fields (“Look! Horsies!”), the peace and quiet I found beside the Ouseburn stream, or the wonderful — and hope-full — garden fence mural I passed almost every day, sharing my walks enhanced my appreciation of my local area, and provided something to talk about with my friends beyond the realities of life under lockdown.

Fran shares walks with me too. I especially remember following her on a walk around Sitges, near Barcelona in Spain. We chatted as she explored the old town and seafront, and I followed her location using Glympse and Google maps. In a similar way, Fran used to share her walks around Peaks Island where she lived at the time. In-person walks with Aimee through Carlisle Park and up Ha Hill in Morpeth, and an urban ramble around Newcastle last year with my friends Paul and Fiona are further examples. Health-wise, I find long walks more challenging than I used to, but I look forward to many walks with friends in the future.

8. Share Quiet Time

So far, my suggestions have involved doing things, but it can be just as valuable to do nothing — or very little — with your friend. Whether it’s meditating together, sharing companionable silence because you’re tired or otherwise occupied, or even dozing off with your friend, quiet time brings its own reward.

9. Get Up On the Stage

It won’t be for everyone but watching your friend perform, or having your friend’s encouragement and support while you do, is a wonderful thing. I’m by no means a natural on stage but I’ve performed live readings of my poetry and excerpts from High Tide Low Tide, and it was particularly meaningful to have Vikki in the audience on a few of those occasions. Likewise, I’ve watched Vikki and other friends on stage in pantomime, karaoke, and open mic sessions. I’ve also been there to support Aimee speak at a number of events, including one for World Mental Health Day in 2019. Whatever the event, there’s nothing like applauding your friend for their courage and talent, and being applauded in turn for yours.

10. Volunteer Together

I’ve mentioned Vikki and Aimee a lot in this article (I don’t have many local friends!) but they get another shout-out here because I met each of them through volunteering with the mental health charity Time to Change. I’ve enjoyed volunteering with them and other friends at a number of events, including Pride and a Halloween fundraising event for Newcastle Recovery College. It’s a great way to meet new people and get outside your comfort zone for a little while. The prime example of that for me was volunteering to zip-line from Newcastle’s mighty Tyne Bridge to raise funds for homelessness charity Crisis.

Likes and Dislikes

In this article I’ve shared ten ways I’ve found to share quality time with friends that don’t involve talking about our mental health. That’s not to say no such conversations ever occur while we’re doing these things, because sometimes they do. That’s perfectly natural, but the point is we’re sharing time regardless of whatever might be going on for us, for the simple pleasure of each other’s company.

It’s worth mentioning, however, that sometimes our mental health might influence the activities we feel able to do, whether due to triggers, anxiety, stress, or other factors. Be aware of that when planning activities with your friend, and be open to the possibility that plans may need to change, be postponed, or even cancelled. Mental health aside, we all have different likes, interests, and preferences. Not everyone would enjoy a crowded music venue, for example, even before the pandemic. Likewise, going for a four hour walk or volunteering would not be to everyone’s taste.

Talk with your friend about what they’d like to do together, and be creative about the possibilties. If Fran and I can do this, living as we do on opposite sides of the Atlantic Ocean, I’m confident you and your friend will find plenty of things you can do too!

Over to You

What do you and your friends enjoy sharing? In what ways does it help build your friendship? Do any of the things I’ve suggested appeal to you? We’d love to hear your thoughts so do get in touch, either in the comments below or through our contact page.


Photo by Valiant Made on Unsplash.


Wednesday, 20 April 2022

40 Mental Health Blog Topics From the Caring Friend's Perspective

Whether you’re an experienced blogger or starting out on your blogging journey, one thing I can guarantee is that you’ll sometimes struggle to find a new or engaging topic to write about. In this post I’m sharing a number of topics from my personal ideas cache, with a focus on supporting friends or loved ones who live with mental health conditions. I’ve used some previously — see examples below — but most I’ve yet to write about.

For convenience I’ve grouped them into themes: Blogging, Support, Healthy Friendships and Relationships, About You, Ideas and Inspiration, and Mental Health. I’ve also included links to a few other lists of mental health topics.


1. My aims and aspirations for my blog.

2. How did you choose the name for your blog?

Example: Ever Wonder Why Our Blog Is Called Gum on My Shoe?

3. Five things I will never blog about and why.

4. How I write my blog posts.

Example: Secrets of a Successful Blogging Workflow

5. The best and worse things about being a mental health blogger.

Example: When Blogging Is Hard and What to Do About It

6. Finding good copyright-free illustrations.

Example: How to Choose the Perfect Image for Your Blog Post


7. How to use social media to support your friends and loved ones.

8. Why it’s important to have different kinds of support networks.

Example: Spokesfriends and Insular Groups: What Kind of Support Network Do You Have?

9. Virtual vs “real life” friendships and support.

10. Online mental health resources I’ve found helpful.

Healthy Friendships and Relationships

11. Ten ways to spend quality time with your friend.

12. How to reconnect (or not) when a friendship breaks down.

13. Envy and jealousy in a caring relationship.

14. How getting it wrong led me to a deeper understanding of what my friend lives with.

15. How to ask the right questions (and listen to the answers).

16. Healthy boundaries: when to say yes, and when to say no.

17. Six things I want my friend to know.

18. The friend you need and the friend I need to be.

19. How to build and maintain a mutually supportive friendship.

About You

20. How did you become a mental health blogger?

21. Write an open letter to yourself.

Example: Dear Marty: An Open Letter to Myself

22. One argument (or mistake or setback) that had a lasting positive result.

23. Things I’m grateful for.

Example: 11 Things I’m Grateful For This Week

24. Things no one knows about me.

Example: 21 Things You Didn’t Know About Marty

Ideas and Inspiration

25. My top inspirational music tracks.

Example: Twelve Songs That Remind Me What Caring Is All About

26. Five mental health books I’d recommend.

27. People you respect and admire in the mental health community.

Example: Six People I Admire in the Mental Health Community

Mental Health

28. An open letter to my friend after her overdose.

29. Can you ever really understand if you’ve not experienced mental ill health yourself?

30. What not to say when your friend is depressed (or anxious, or in mania, etc).

31. Three mental health terms I never understood — until I did.

32. 99 words on depression (or any other mental health condition).

33. Healthy habits and how to keep them.

34. What self-care means to me.

35. How to educate yourself about your friend’s mental health condition.

36. An interview with your friend about what it’s like for them living with mental illness.

37. Five things you’ve learned about mental illness.

38. How to be a mental health ally.

39. The best and worst mental health memes you’ve seen.

40. Mental health awareness days and events — are they helpful or do they trivialise how things are for your friend and others living with mental illness?

More Mental Health Blogging Ideas

Check out the following links for more mental health blogging topics.

For more specific ideas, search for “blogging ideas for depression” (or anxiety, bipolar disorder, etc).

Over to You

I hope you found these ideas interesting and useful. Please feel free to use or adapt any of them as you wish. There’s no need to link back to his article, though I’d love it if you did! If you tag me or let me know you’ve used one of these topic ideas, I’ll be sure to share a link to your post on our social media.



Photo by Nick Fewings at Unsplash.


Wednesday, 13 April 2022

I Want to Write: How Our Book HIGH TIDE LOW TIDE Came to Be Written

This is the story of how our first book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder came to be written, taken from the book’s Preface. It’s available from all good booksellers; check our book page for details.


Writing has always been an important part of my life. I remember the teacher who encouraged me by providing a notebook for my extracurricular stories. I remember being snubbed by my classmates for asking if I could submit a poem in place of the expected essay: our teacher thought it such a good idea he set poetry for the entire class. I remember volunteering as assistant editor on the school magazine because I had a crush on the teacher. I remember the yellowing copy of Ezra Pound’s poetry I borrowed from the library and neglected to return. I wrote poetry through sixth form (my final two years at school) and university; later essays, articles, and short stories. I have kept a personal diary for over forty years.

A keen science student, I studied pharmacy at the University of Bradford, Yorkshire. I graduated in 1983 and took up a postgraduate position at the Department of Neurology, Institute of Psychiatry and King’s College Hospital Medical School in London. In 1987, I moved north to work in the biomedical sciences laboratory at Newcastle’s Royal Victoria Infirmary. I met my wife Pam that same year. I later retrained in business computing and have worked in the information technology services industry ever since.

I met Fran Houston online in May 2011. Fran lives with bipolar disorder, chronic fatigue syndrome, and fibromyalgia, and we joke that when she discovered I was a pharmacy graduate with three years’ research experience in neuroscience she thought all her worries were over. Here at last was someone to sort her life out for her! In fact, little I had learned in the lecture theatre or laboratory prepared me to help someone living with chronic, debilitating illness. Education is extremely valuable — I have completed a number of courses and workshops since meeting Fran which help me support her more effectively — but ultimately caring is not about how much you know, it is about who you are and what you do.

This book was conceived in October 2012. During a phone call with Fran I mentioned that I felt inspired to do something creative. Without hesitation, she suggested I write a book about befriending someone who lives with illness. The idea made a great deal of sense. Despite living three thousand miles apart, we had forged a relationship that was strong, caring, and mutually rewarding. I saw immediately that my experience could be of value to others. But if the suggestion was inspired, it was also scary. My first thought was that I had never looked on her as “someone living with illness.” I saw her as my friend.

That is the point, Marty! It is how you are with me. People do not usually treat me that way once they know I have illness. It is a powerful thing. It has helped me see that I am not just my illnesses. I have value and gifts to give.

In the weeks that followed, we discussed possible approaches, formats, and the likely audience for such a book. I researched similar titles, made notes, and sketched outlines. The further I pursued the idea the more it eluded me. I could see the book only as an autobiographical account of our friendship, and while that could be a tale worth telling, it wasn’t what Fran had envisaged. I began to lose heart. Our conversations turned to other topics and the idea of the book lapsed.

One night in late November, Fran telephoned me. It was four o’clock in the morning here in the UK. She was very excited. She had been to dinner with someone who wanted advice on how to support a friend diagnosed with bipolar disorder. Fran offered suggestions from her own experience, and mentioned she knew someone in England who was writing a book on that very subject. Her friend thought it was a great idea and wanted to know when the book would be published. My heart sank. Too sleepy to be anything but honest, I told Fran what I had come to realise, but had not until that moment shared with her. Our book was never going to happen. Fran didn’t press me for details or explanations. She said goodnight and let me get back to sleep.

I went to work next day as usual, and avoided thinking about our conversation until I was walking to catch the train home. It was a shame nothing would come of Fran’s idea. My thoughts turned to a book on depression I had recently finished reading. Written by a clinical psychologist, it had an easy style and was illustrated with snippets of conversation. It was nothing like the book Fran and I had talked about, but could a similar approach work for us? Something clicked. I messaged Fran from the train.

Thank you for mentioning our book to your friend last night, for telling me about her reaction to the idea, and for the response it stirred in me. It was the jolt I needed. Just now, in the very act of repeating to myself how our book will never come into being, I caught a glimpse of how it might. I want to rededicate myself to the project. I want to start making notes, drafting ideas. I want to write.

It was a breakthrough moment, and one utterly in keeping with the central message of the book you are holding. No matter what happens or what you are struggling with — be that some practical or creative project, your relationship with others, your own health or that of a loved one — the important thing is to set aside preconceived notions of how things should be, or whether you are up to the task. Instead, be honest with yourself about what is happening. Acknowledge your limitations, but refuse to be bound by them. Trust in your ability to grow to meet the challenge. Recognise joyfully the potential of each moment. Be who you are. Do what you can. Embrace the journey.

Martin Baker
Newcastle upon Tyne, UK


Photo by Thought Catalog on Unsplash.