Wednesday 29 September 2021

Return to Down: How My Baseline Mood Has Slipped from Positive to Low

I’ve felt below par mentally for a while now. It’s possible I’ve been depressed, although I’m wary of self-diagnosis and haven’t sought a clinical opinion. I can trace some of it back several years but I’ve only lately felt up to talking about it publically. It’s not that I’ve ignored my mental health altogether. I’m aware of many of my triggers; the situations and events that tend to pull the rug out from under me. I captured the main ones in my Wellness Recovery Action Plan (WRAP) back in 2019, and review it periodically. My triggers include:

  • Changes in relationships (which I tend to perceive as lessening, loss, or abandonment)
  • Uncertainty or lack of clarity in communications
  • Getting overwhelmed by competing demands for my time and attention

My triggered responses include feeling anxious and panicky, a strong sense of loss or abandonment, and becoming either pushy or clingy. My WRAP includes recovery strategies which help me return to my baseline, such as talking things over with Fran and other trusted friends, pulling back to assess what’s happening, and focusing on my writing. These strategies have served me well, until now.

In last week’s blog post, I mentioned feeling flat, low, and empty, but being unable to identify any of my usual triggers. My key friendships and relationships have been solid for a while now, communications are clear and unambiguous, and although there’s been a lot going on, I’ve not felt consciously overstretched. Nevertheless, my mood has often dropped suddenly — at times precipitously — with little or no warning. Something is different but it’s taken me a while to figure out what it might be.

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 — essentially any of the things I was grateful for last week — 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. I’m reminded of the rubber band effect Fran uses to describe the “rebound crash of pain and fatigue” she gets with her fibromyalgia if she exercises or exerts herself too much.

No model can be completely accurate, but the best can help us — and others — appreciate what’s happening in our lives. Fran and I have used a variety of models to explore how illness plays out in her life. We describe several in our book, including this layers model:

In terms of responsibility, Fran finds it helpful to acknowledge there is an underlying layer of biological illness. It may respond to clinical intervention, including medication, but she is unable to influence it directly. Above this, there is another layer which Fran can affect, through meditation and mindfulness, exercise, and making healthy choices about her food, drink, and sleeping regimes. Thinking about illness in this way eases the burden of guilt, and allows her to focus her energy where it can be most effective.

I only began explicitly tracking my mood in February 2020, but three times a day for six months I rated my mood on a six-point scale that ran from zero (“struggling”) through “low,” “flat,” “OK,” “baseline/positive,” up to a maximum value of five (“really good”). My healthy-baseline-with-occasional-low-periods model remained valid throughout. Outside events and changes (either real or imagined) in my relationships evoked sudden and occasionally dramatic drops in mood, but I returned to my positive baseline without much trouble or delay. As I noted at the time, “My mood is closely tied in with what’s happening in my life, especially in my key relationships. This isn’t news to me (or my close friends) but the tracker has brought it into clearer focus.”

I haven’t tracked my mood since last August but on that same scale I’d say my baseline has dropped from “positive” to somewhere between “flat” and “low.” That’s a significant shift but how and when did it occur? I found it hard adjusting to working from home and not meeting up with friends during the first covid lockdown, but my baseline held up, as my mood tracker attests. I can think of events towards the end of 2020 that upset my equilibrium and might be significant, but the first clear sign of change is an article I wrote in March this year. In What If I Never Do All the Things I Used to Do? it’s clear I was struggling to remain positive.

At some point, though, it dawned on me that things will never return to how they used to be. The impact of covid, of lockdown, of all the changes we lived through last year and are still living through, is simply too great for us to pick up where we left off. Vaccinations will allow us to move forward but right now, as England begins gradually to open up again, I can only see that many things I valued (and some I took for granted) have already gone beyond any hope of retrieval. Others may resume, but they won’t be the same. I’m not the same. We aren’t the same. How could we be, with all we have gone through?

Contrast that with the robust optimism of “Remember When?” — Building Shared Experience in Unprecedented Times, written one year earlier, a month or so into the pandemic.

It occurred to me that we’re doing more than checking to see people are okay. We’re supporting each other, yes. But even more than that, we’re sharing our experiences in what truly are unprecedented times. [...] There will be tears and pain when we look back on the pandemic of 2020. But there will also be joy and laughter, and the comfort that comes from surviving dark times in good company.

I may revisit these blog posts now things have largely opened up again. I’ve been able to meet up with local friends. I’ve reclaimed a couple of things I feared lost forever and found some new ones. Nevertheless, this lower baseline appears here for good — or bad. However I got here, I need to figure out what that means. In another recent post I shared a little of the changes I’ve noticed in my daily diary:

Looking through my journal, there are things I’m used to hearing from others but have rarely felt — and even more rarely expressed. Have I just been feeling low or is it something more serious? I tend to assume my experiences, dark moods included, scarcely register compared with what others go through. But what if I’ve reached somewhere they would recognise. How would I know?

Feeling low is scarcely unique or unexpected given all we’ve lived through these past eighteen months. It’s unusual and unexpected for me, though. I’ve become much less positive, optimistic, and hopeful than I can remember being in a very long time. In unguarded moments, I’m overwhelmed by a deep, aching emptiness. I can shift my mood, but sooner or later the rubber band takes hold and I find myself back on my new baseline. Is this (to use a term I’ve come to loathe) my “new normal”?

I’m unsure what to do about it. Maybe there’s nothing to be done about it, other than to keep moving and see it through to the other side. Being open about how I’m feeling is part of that. I was chatting with my friend and fellow mental health blogger Aimee Wilson last week:

Hi Marty. What are you up to?

Doing a bit of blogging. The one about my mood shifts.

Are you finding it OK to write about that kind of thing?

It’s not flowing all that well at the moment, but yeah. It feels kinda important and real, yunno?

That’s so good!

Thanks. I’ve learned from the best!

A few days later, we had the opportunity to talk face-to-face. I shared my insight about my baseline shifting downwards, and how I was tryng to figure out what it means. We discussed how people often set their needs aside — sometimes for years — in order to support others who may be in more immediate need. Eventually, though, things may catch up with them to the extent they can no longer be ignored. That was very much the case with my mother. She supported my father for decades as he became increasingly disabled with arthritis. After he died and I left home for university, she devoted herself to supporting other people. Her mental health deteriorated to the point where she was barely able to cope. She spent her final years depressed, anxious, and wracked with guilt for not having done more. At her funeral, the minister praised her as a living saint, but to me, that degree of self-neglect is far from laudable.

Something that feels very relevant is the convenient but problematic labelling of people as either “ill ones” or “well ones” (as Fran and I express it in our book). The distinction has value but it can lead people like me who are relatively well and stable to ignore or downplay signs we’re not doing so well. Aimee and I agreed that health, especially mental health, is not a competition. No one should be shamed or ignored because they imagine they’re struggling less — or more — than someone else.

Things change. Situations and relationships change. Our health changes, sometimes for the better, sometimes not. We all need to pay attention, me included.

This is me paying attention.


Photo by Adrian Dascal on Unsplash


Wednesday 22 September 2021

Seven Things I'm Grateful for This Week (And One Extra Special One at the End)

I was inspired to write this post when the topic of gratitude came up twice for me in as many days. The first was when I was discussing journaling and gifting with my friend Brynn. It reminded me of the gratitude journal I was gifted a couple of years ago. I used to carry it with me everywhere and wrote in it regularly, but it’s sat on my desk for a while now, unused and rarely opened.

The second was when I opened Spotify to play some music on one of my evening walks and noticed a podcast on radical gratitude by my friend and fellow blogger Liz Kay. I’d added it to my Spotify library a few weeks ago but hadn’t got round to listening to it. I played it on my walk, captivated by Liz’s gentle passion for the subject, and have listened to it several times since. If you’re at all unsure about the benefits of gratitude, I recommend giving it a listen. There is a blog version here, if you prefer to read rather than listen.

To be honest, I wasn’t feeling much in the mood for gratitude at the time. I’ve been flat, low, and empty for a while now and had considered exploring that in a blog post. It seemed churlish, however, to reject the invitation to think more positively. So here, in no particular order, are seven things I’m grateful for this week.

Sexy Rexxy

I enjoy computer programming, but my day job as Associate IT Services Manager offers little opportunity to put my skills to use. It wasn’t that way in the past but things change. Chances to do fun stuff like that are few and far between. Nevertheless, this week I created one. I’d been pondering how best to validate a particularly complex file I’ll be receiving from another team in the near future. I’ve done it manually before and it’s tedious in the extreme. It occurred to me I might write a program to generate an equivalent file of my own, against which the new one could be easily — and automatically — compared.

No one had asked me to do so and I wasn’t certain the idea would work, but I figured it was worth the couple of hours it would take to find out. I spent a happy afternoon coding it in Rexx and can honestly say I had a great time doing so. It worked, too, and led me to investigate some anomalies with format of the files I’d not noticed before. The exercise lifted my mood and left me feeling more engaged than I’ve been in a while. I’m grateful to work for an employer where that kind of exploratory, ad hoc, enquiry is encouraged.

Positive Response to My Masking Article

I’m grateful for any response to my weekly blog posts, but last week’s article High Masking or Faking Fine? The Masks We Wear and Why We Wear Them received a far more positive reaction than anything I’ve written in recent months. I’m particularly grateful to Dr Carla Groom, whose talk on neurodiversity in the workplace inspired the article in the first place. She told me she was touched I’d been moved to write the post, and generously suggested some changes to align it more closely with what she’d said in her talk.

My article attracted very positive responses on LinkedIn, with one reader calling it “[a] fantastic read — inspiring, thought-provoking and poignant.” Another said it was “[a] powerful read from a perspective you don’t hear about very often.” I logged into work that day to find one reader had been moved to share it with colleagues across the organisation. Other recent blog posts have also been well received and shared at work within our Mental Health First Aider community, including my piece on men and mental health, and an article for World Suicide Prevention Day.

At times, I doubt the value of my writing. Positive feedback like this reassures me that, sometimes at least, I get it right.

Good Food and Good Company

Last month, I wrote a blog post on safety, responsibility, and trust inspired by a drive I took with a friend. We met again last weekend and took another drive out to a lovely pub for lunch and a catch-up. We’ve been friends for a number of years and it’s fair to say things haven’t always gone smoothly, but we are in a good place now. I’m immensely grateful for our friendship, and look forward to our next trip out together.

Friends Who Notice How I’m Doing

I’m fortunate in having friends who notice when I seem a bit off, and ask if I’m OK. Aimee did so the other day:

“Are you ok, Marty?”

“Kinda flat/low.”

“I did wonder …”

She asked if I could pinpoint any reason for how I was feeling. I couldn’t, but it helped to be asked, and in a way that didn’t put pressure on me to explain or share more than I felt comfortable doing.

I had a similar conversation the same day with my friend Brynn, which brought a little levity to the situation. She asked how I was and I said I was feeling flat, low, and empty. This led to me coining the word flempty, which I’m sure I will use again! I’m grateful for Brynn’s friendship and the fact we can talk about serious things one moment, and crack ourselves up laughing the next.

It’s the Little Things

Sometimes it’s the little things that mean the most. I’ve written about this before, and Liz mentions it in her gratitude blog and podcast:

DON’T DOWNPLAY THE SMALL THINGS! As they come up, just try to consciously think to yourself “hey, that was actually kind of cool!” By making a habit to acknowledge the small things as they arise, you are working to engrain thoughtfully thoughtless gratitude into your daily life and practices.

There have been a few “actually kind of cool” things this week. Aimee has been sharing photos and video clips of how her new bunny Luna and her cat Emmy are getting along. I don’t think I’ve ever typed “awwwwwww, cute!!!” as many times as I have to Aimee in recent days! I’m grateful for these behind-the-scenes glimpses which bring a touch of warmth and delight, no matter how I’m feeling or what might be going on for me.

In a similar way, Brynn shares photos and videos with me of her beloved dog Beckett. We also exchange YouTube music videos. She’s far more musically knowledgeable than I am — as she says, “I’m a music person, Marty!” — and loves to introduce me to artists and tracks I’ve never encountered before. It’s fun for me, too, trying to find songs Brynn may not know.

Turning the Page

Back in 2017, I wrote about how Fran and I read together; more specifically, how I read aloud to her. Over the years, we’ve read a wide variety of books: fiction, nonfiction, long, short. At some point, for no particular reason, we stopped doing so, and I’ve missed it.

A friend of ours, award-winning arts writer and journalist Bob Keyes, who interviewed us in 2019 for the Maine Sunday Telegram, has a new book out about American artist Robert Indiana. Fran and I watched a couple of Bob’s interviews when the book came out, and it felt natural to read it together. So that’s what we are doing! I’m grateful for the opportunity to read to Fran again, and to learn about an artist I knew nothing about.

First Leaves of Autumn

I went for a lunch time walk last Thursday and for the first time this year found a drift of dry fallen leaves to walk through. There’s nothing like that first crunch of autumn! It was a moment of simple delight and joy, which I shared with Fran in a photo. (In retrospect, I should have recorded a video so she could hear it too!)

Last But By No Means Least

I’ve listed seven things I’m grateful for from the past week, but I’d like to close with a special mention for Liz Kay whose podcast on radical gratitude inspired me to do so.

Liz — we don’t know each other very well I guess, but please know that you mean a great deal to me. I remember us first connecting early this year when I was on one of my local walks, and the voice messages you sent me. (I’ve just gone back through my messages and replayed some of those — which brought warm smiles of remembrance.) Whether it’s through the medium of your blog, or your podcasts, in personal messages, or in your Facebook groups, you share so genuinely and honestly, and always from the heart. I’m grateful, happy, and proud to call you my friend. Bless you.

Check out Liz’s social media links here.


Photo by Gabrielle Henderson on Unsplash


Wednesday 15 September 2021

High Masking or Faking Fine? The Masks We Wear and Why We Wear Them

This article was inspired by two online sessions I attended last week. The first, on neurodiversity in the workplace, was presented by Dr Carla Groom, Deputy Director of Behavioural Science at the Department for Work and Pensions (DWP). Dr Groom described what neurodiversity means (and doesn’t mean) and shared from her lived experience as someone diagnosed as being on the autistic spectrum.

Discussing labels, she said she prefers the term autistic spectrum condition (ASC) to autistic spectrum disorder (ASD), which is the medical term for what was previously called autism. But what resonated most for me was what she said about the label "high-functioning." On one level, she conceded, the term describes her well (her LinkedIn profile describes her as a “[s]enior leader and behavioural science pioneer”). She nevertheless hates it when applied to her autism, because it denies or dismisses the work and effort that goes on behind the scenes for her to present this way and achieve the success she has:

[S]omeone like me might be called high-functioning. And fair enough, I am high-functioning by most reasonable definitions. But if you then say I have “the high-functioning kind of autism” or that my autism is “mild”, then I might get a little bit cross and say that I work extremely hard to make it mild for you. It affects everything about my experience of the world, for good and bad. To deal with a world designed for a completely different kind of human, I am constantly planning, risk assessing, coming up with mitigation strategies and suppressing my anxiety when those don’t work. They are invisible struggles.

These coping strategies are called “masking” and it’s exhausting. I’m working to mask less and embrace my difference. That means, ironically, that I will seem more “autistic”, but I’m hoping that gives permission for other people to step outside narrow ideas of desirable behaviour, and see that there are many different ways to achieve good outcomes.

Summarising it for me later, Dr Groom said, “I don’t mind being called ‘high-functioning,’ although I do think ‘high masking’ is more helpful.”

I’m in no way qualified to talk about masking (also called camouflaging) in relation to autistic spectrum condition, but I found this description helpful:

Hiding who you are is an uncomfortable and exhausting experience. For many autistic people, that experience is a daily reality. In places where the full spectrum of neurodiversity is not understood or welcomed, autistic people often feel the need to present or perform social behaviors that are considered neurotypical. Some people may also feel they have to hide neurodiverse behaviors in order to be accepted.

I’ve included a list of resources at the end of this article if you’re interested in learning more.

Dr Groom’s account reminded me of something I learned early in my friendship with Fran. Whilst she doesn’t use the terms masking or camouflaging, Fran has often spoken in similar terms about how hard she works to present well in public, so as to fit in and not attract unwanted or hostile reactions. By that, she means hiding or minimising the impact of her mental and physical health conditions. Fran’s symptoms vary in frequency and severity but include mania, depression, suicidality, pain, and debilitating fatigue.

Fran hides these away because being open about her conditions can lead — and has led in the past — to varying degrees of stigma, rejection, and disrespect. I’m one of the relatively few people she trusts enough to be honest with, but even with me, there are things she tends to keep to herself. She’s not alone in this, of course. We all do it, to some extent. I do it, albeit for different reasons. We call it faking fine.

The downside is that the people Fran is “presenting well” to never learn the truth. Whether on social media or in person, they see the places she goes, the people she knows, and the things she achieves, and assume she’s okay. The reality is rarely so simple. They don’t see the courage and sheer hard work it takes for Fran to manage her conditions and make the best life she’s able to. This makes me sad, but I understand why she does what she does. It’s not Fran’s job to educate society to accept the realities of her life. She does what she needs to do, which includes presenting in ways calculated to evoke fewer unhelpful, ignorant, or hurtful reactions.

Fran is not alone in this, nor is it limited to mental illness and neurodiversity. One friend told me she experienced something similar following surgery on her hand. People saw the functionality she’d regained but didn’t necessarily appreciate the hard and painful work it took to achieve and maintain mobility, or the prescription pain medication she still needed.

Whilst useful, masking or “faking fine” can be extraordinarily frustrating and exhausting, given the effort involved in presenting as “fine” or “high functioning.” It’s an effort and burden that, almost by definition, goes unrecognised. It can have more serious consequences if it deepens a sense of disconnect and lack of awareness between the person wearing the mask and those around them.

The second talk I attended was organised by UK suicide prevention charity Grassroots, for World Suicide Prevention Day. Mental health advocate, broadcaster, and author of A Walk from the Wild Edge, Jake Tyler described his experiences during lockdown in 2020.

Asked about the theme of this year’s World Suicide Awareness Day, “Creating Hope Through Action,” he said the most important action he’d taken during lockdown was to nurture the relationships that meant most to him. Connecting online, rather than face-to-face, had opened him up to people and friendships that might not have developed or grown as they did had it not been for lockdown. Those connections had been powerfully protective in the context of suicidality and self-harm.

I brought this up the next day on a work call with fellow Mental Health First Aiders. We agreed that working and socialising virtually had changed our relationships with friends and co-workers, in many cases for the better. Connecting virtually on video calls as we worked from home allowed us to let down our usual masks to some degree, and interact more genuinely. In the words of one colleague, “The biggest positive from the past eighteen months or so is the way people have connected more deeply with each other.” I’ve noticed this in my own connections with friends and colleagues, although it’s not necessarily so for everyone. Setting our masks aside, whether virtually or in person, requires a depth of trust that’s not always present, and cannot be assumed.

Is mask-wearing healthy or not? I don’t think there’s a definitive answer to that question. I prefer to think of it as useful; necessary, even, in some circumstances. It can be a strategy for navigating a society unsympathetic of — and impatient with — anyone unable or unwilling to meet its behavioural norms. It’s neither kind nor helpful to coerce people into setting their masks aside, especially if that involves shaming them into doing so or suggesting mask-wearing is in some way dishonest or deceitful. We wear our masks for a reason and no one has the right to deny or invalidate those reasons.

Our aim, as individuals and as communities, must be to build and maintain spaces in which we feel safe to set our masks aside when we choose to, but also feel safe to use whatever masks and strategies we need to, without risk of censure.

That can only happen when we are aware of the masks we choose to wear, and the reasons for doing so. We can start by challenging the stigma associated with mental illness, invisible illness, disabilities of all kinds, and ways of apprehending the world that are other than neurotypical. What matters most is how we relate to and treat one another, however we present, recognising that without a doubt there’s more going on for each of us than we see or choose to share.


Further Reading

What is autism? (NHS)

What is autism? (National Autistic Society)

Blending Into the Crowd: What is Autism Masking? (Autism Parenting Magazine)

Autism Masking: To Blend or Not to Blend (Healthline)


Photo by Izzy Park on Unsplash.


Friday 10 September 2021

Free Books for World Suicide Prevention Day

To mark World Suicide Prevention Day 2021 Fran and I are offering our book HIGH TIDE LOW TIDE for FREE on Kindle for five days between Friday September 10 and Tuesday September 14, inclusive.

Once the free offer is over the prices will go back to normal.

In High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder we share what we’ve learned about growing a supportive, mutually rewarding friendship between a “well one” and an “ill one.” With no-nonsense advice from the caring friend’s point of view, original approaches, and practical tips, our book is illustrated with real-life conversations and examples.

Buy it here.

World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organisation. This year’s theme is Creating Hope Through Action:

Creating Hope Through Action is a reminder that there is an alternative to suicide and aims to inspire confidence and light in all of us; that our actions, no matter how big or small, may provide hope to those who are struggling. Preventing suicide is often possible and you are a key player in its prevention.

Through action, you can make a difference to someone in their darkest moments — as a member of society, as a child, as a parent, as a friend, as a colleague or as a neighbour. We can all play a role in supporting those experiencing a suicidal crisis or those bereaved by suicide.

This is a topic very close to our hearts and never far from our thoughts. Suicidal thinking has been part of my friendship with Fran since we met ten years ago, and we devote one chapter of our book to dealing with how to support a friend who is feeling suicidal.

For more information check out the following links.


Wednesday 8 September 2021

Maybe Even Save a Life: Our Message of Hope for World Suicide Prevention Day

It may not be easy but you can help someone make a life worth living. Maybe even save a life. (Fran Houston)

World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organisation. This year’s theme is Creating Hope Through Action:

Creating Hope Through Action is a reminder that there is an alternative to suicide and aims to inspire confidence and light in all of us; that our actions, no matter how big or small, may provide hope to those who are struggling. Preventing suicide is often possible and you are a key player in its prevention. Through action, you can make a difference to someone in their darkest moments — as a member of society, as a child, as a parent, as a friend, as a colleague or as a neighbour. We can all play a role in supporting those experiencing a suicidal crisis or those bereaved by suicide.

This is a topic very close to our hearts and never far from our thoughts. Suicidal thinking has been part of my friendship with Fran since we met ten years ago. Indeed, it’s how we met, when we each reached out to a young woman who was expressing suicidal thoughts on her social media page.

For WSPD 2020, we posted a selection of relevant articles from our blog. This year, we’re sharing an excerpt from the chapter of our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder which deals with supporting someone when they’re feeling suicidal. In the spirit of “creating hope through action” we hope it conveys the vital message that each one of us can make a difference to those we care about.

High Tide, Low Tide will be available FREE on Kindle for five days, September 10–14, 2021.


How Can I Leave?

I remember clearly the first time Fran told me our friendship was one of the main things keeping her alive. I was profoundly moved, but had the presence of mind to realise this was not as simple as it appeared. In a moment of insight I said, “You may come to hate me for that, Fran.” Her reply was immediate and sincere. “I’m already there.” It has become something of a private joke between us, but it is a joke with edges.

Fran: I wish I hadn’t met you. I’d be gone already.

Martin: I told you long ago, Fran, that you would come to hate me for that. You’d better get used to it. You have years of hating me ahead of you!

I asked her once if she truly believed she would not be alive if it were not for me. “Yes it is true. You hold me here. You nag and pull and push at me all the time with your love and your care. How can I leave?”

Nagging aside, I help Fran best by staying with her, listening to what she is saying, and then engaging with her calmly. I bring negative or skewed thinking to her attention, offering positive alternatives wherever possible, but I never dismiss or trivialise what she is going through. I do not tell her not to worry, or that everything will be all right. I have never promised to keep our conversations secret if I believed secrecy would endanger her. Fran knows I would do everything in my power to keep her alive, including bringing in other people and agencies if it became necessary.

But it would be wrong to imagine I never feel scared or get things wrong. In the summer of 2013, Fran was traveling in Europe with her parents. At the end of a particularly hard day, we shared a thirty minute telephone call, the longest we had managed in several days. The following is from my diary, written later that evening.

Fran was pretty drunk tonight and I got on her case about that without listening to her side of things. Towards the end of the call she suddenly became very weepy about how much she loves her Mom. I stayed with her until she was cried out, and then we parted so she could walk back to the hotel. I haven’t heard from her since. Given how tipsy and tearful she was, I could do with knowing she got back OK. I’ve texted her and left messages, but no reply yet.

What I failed to record in my diary, because I scarcely dared to, was that before bursting into tears Fran had said, “If I don’t make it back to the hotel, I need Mom to know how much I love her.” She had never spoken like that before, but I did not challenge her or ask what she meant, perhaps because I had already given her a rough time about her drinking. I said she could count on me to tell her mother if anything ever happened to her. That seemed to reassure her, but after we parted, I started to worry. Had she, even subconsciously, been hinting at something darker? I did not seriously believe she intended to kill herself, but it was a horrible feeling, which deepened as the hours passed. What if she had stepped into traffic, or thrown herself from a bridge? What if that conversation had been our last? What would her mother think of me? Her friends? Everyone would blame me for not keeping her safe.

I went to bed, but kept waking and checking my phone for messages. I finally heard from Fran around five thirty in the morning (six thirty for Fran). She had reached the hotel without incident, but had then been sick and still felt poorly. She had tried to contact me, but the hotel’s Internet service was down and she had only a poor phone signal. I mentioned our telephone conversation. She scarcely remembered it, but assured me she had definitely not felt suicidal.

The experience taught me to stay focused on what is happening whenever I am with Fran, and to bring any hint of dark or suicidal thinking into the open, rather than ignore or dismiss it. If your friend lives with suicidal thinking, or has made a suicide attempt in the past, I recommend educating yourself about a subject that can be difficult and painful — yet also extraordinary and courageous — to approach. We look at awareness and education later in this chapter. In an emergency, or if you are in any doubt as to your friend’s safety, do not hesitate to contact a doctor, hospital emergency department, or crisis helpline.

A Promise Is a Promise

Long before we met, Fran made a commitment to her psychiatrist that she would not kill herself without contacting him first. In her words, “It was a soul promise, made eye to eye.” She still considers it in force. It is arguable how much weight her word would carry in a time of crisis, but I knew from the beginning I would never ask her to make an equivalent commitment to me.

One thing, Fran ... and this is something I have wanted to say to you for a while. I will never ask you to give me your word not to kill yourself. That is a lie of course. In desperation I would beg you to promise. On my bleeding knees I would beg you. But if I cannot trust your word already given (and more importantly if you cannot), if you ever reach a place where that is not enough, what difference would a promise to me make?

I once told Fran that if she ever chose to leave, I would not hate her for it. That might seem at best naive, and at worst dangerously close to condoning her suicide, but my promise was instinctive and heart-felt. I also believe it to be protective. Fran later told me how important my words were to her. Paradoxically, they gave her strength to go on. Most people, she said, “try to lay guilt on you about how bad they’d feel if you killed yourself.” That argument would never persuade her, but dealing with it drained her of the energy she needed to fight to stay alive. My promise not to hate her finds an echo in the words a friend shared with us concerning her son’s attempt to end his life.

When I got to the hospital that night, I decided that if he died, today or any other day, it would be OK. But I needed to tell him that. So I told him, I cannot comprehend why he is the way he is, but, if he succeeds one day, I just want him to know. It will be OK, because alive or dead, happy or sad, no matter what ... I LOVE YOU.

Other Hands and Other Hearts

I am not the only person Fran has to turn to. In addition to a committed support team she has friends she trusts to help keep her safe. It is hard to overemphasise how important it is for your friend to have a trusted support network. In a moment of crisis, one person may be available to help when others are not. Early in our friendship, Fran was calling or e-mailing me many times a day. On one occasion I was busy at work and failed to respond. Thankfully, she called another friend who made time to talk with her. I contacted him the following day.

Fran told me you talked with her yesterday, and how important (literally life-savingly important) that was to her. How you know how to handle her like no one else can (I guess we each do in our different ways). I wasn’t available for her yesterday when she was trying to call me. I was at work and had to go Do Not Disturb. I didn’t know she wanted more than a chat. But it wasn’t me she needed, it was you.

I asked Fran what he had said to her. “He said, ‘You just need to stay alive until tomorrow, Fran. You can do it.’”


Excerpted from chapter 7, “The ‘S’ Word: Being There When Your Friend Is Suicidal,” of our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder.


Resources and Links

World Suicide Prevention Day 2021 (Rethink Mental Illness)

World Suicide Prevention Day 2021 (IASP)

Selected Articles for #WorldSuicidePreventionDay 2020

Online Suicide Awareness and Prevention Training and Podcasts

If You Need Help

Our resources page has links to suicide crisis lines and support organisations, training resources, and books. UK mental health charity Mind offers help and information if you need support or are concerned for someone else. The IASP has links to international helpline and crisis centre organisations.


Wednesday 1 September 2021

Self-Harm, Addiction, and Recovery: Thoughts Inspired by My Friend's 365 Day Milestone

This article was inspired by conversations with friends and colleagues, including Aimee Wilson of I’m NOT Disordered who recently shared on social media that she was a day away from celebrating one year free of self-harm. In addition to talking with Aimee about her achievement, in the past week I’ve spoken to two people beginning their respective journeys to shed unhealthy dependencies. One is working to break an addiction to sugar and unhealthy food. The other is determined to give up alcohol and nicotine. Despite very different situations and experiences, certain themes kept coming up, which I want to explore in this article. I should state up front that I have no first-hand experience of self-harm or addiction. My perspective is that of a caring and concerned outsider.

What Is Self-Harm and Is It Addictive?

Self-harm can take many forms. In the words of UK mental health charity Mind, “[s]elf-harm is when you hurt yourself as a way of dealing with very difficult feelings, painful memories or overwhelming situations and experiences.” In the charity’s words, “[o]nce you have started to depend on self-harm, it can take a long time to stop.” The Mental Health Foundation confirms that “[i]t is habit-forming, and some people believe you can become physically addicted to self-harm.” A friend with lived experience told me she definitely sees self-harm as addictive, especially if it is someone’s main or only coping strategy.

Respect and Understanding

When someone we care about engages in harmful practices, our instinctive response is to try and get them to stop. I’ve certainly felt that way in the past. The impulse is understandable, but it’s unlikely to help or be appreciated if it’s imposed without the person’s agreement, and without attempting to understand what led them there in the first place.

Unless the underlying issues are resolved or our loved ones find healthier ways to manage them, they may turn to self-harm again. This is not because they are “weak-willed” or lack what is sometimes still called “moral fibre.” I suspect people who use those terms have no idea what it means to be in such pain that self-harm appears the best or only step to take. Anyone who has been in that situation deserves respect, understanding, and support, not judgment or condemnation.

There’s No Single Road to Recovery

I’m unqualified to discuss how self-harm, addiction, or dependency are best addressed. I’ve included links to a number of organisations in the resources section at the end of this article. That said, it’s clear that no single strategy will be appropriate for everyone. I’m grateful to those who’ve shared with me approaches they’ve found helpful.

The protective effect of treatment for underlying health conditions, including mental health conditions, cannot be overstated. Aimee has written previously about how badly she was affected when one of her prescribed medications was stopped. Her safety was severely compromised until the error was identified and corrected. More generally, Aimee finds aspects of dialectical behavioural therapy (DBT) invaluable in keeping her safe.

Another friend used the Twelve Steps recovery programme when working with addictive behaviours in the past, and still finds it helpful. Under medical guidance, she’s started a new program to address her dependence on sugar/soda, caffeine, and unhealthy eating. She’s currently exploring whether a cold turkey approach, in which she attempts to give these things up all at once, will work for her, or if she’s better titrating herself down more gradually.

Fran and I have experienced our own struggles with weight and eating. We’ve learned how difficult it is to follow healthy strategies, and how complex our relationships to food and body image can be.

Whatever their situation, anyone working to change deep-seated behaviours deserves encouragement and support in doing so, recognising that it may take time to find something that works.

When the Time Is Right

Motivation and timing are hugely important in changing unhealthy habits and coping strategies. Perhaps we’ve reached a point in our lives when we feel we deserve to treat ourselves better. Maybe we’ve been advised to make lifestyle changes that mean reducing our dependence on things we’ve previously taken for granted. Perhaps self-harm or addiction is taking a serious toll on our physical and mental health. Whatever the impetus for change, the right time includes having appropriate support in place. This may include professional involvement. It certainly includes the non-judgmental support of trusted friends and family.

As I mentioned earlier, coercing someone into changing before they’re ready is unlikely to help in the long term. Self-harm might be the only control or agency a person feels they have in their lives. As unhealthy as that may be, prohibiting or preventing self-harm before realistic alternatives are available may do more harm than good. The exception to this is where there is a serious and immediate threat to health or life.

We Are All Dependent on Something

Most of us have unhealthy habits we indulge on a regular basis. Some, such as caffeine, smoking, and alcohol, are more socially acceptable than others, but they’re all unhealthy to some degree. We use them for the perceived benefits they bring, because they make us feel better, or help us manage the stresses in our lives.

I say this not to belittle the devastation that addiction and dependency can wreak, nor to equate my moderate drinking and coffee dependency with alcohol addiction, overdosing, cutting, or drug use. Rather, I believe that recognising our unhealthy behaviours, and how hard it can be to give them up, helps dispel the stigma attached to riskier and less socially acceptable behaviours.

Every Day Is a Victory

No matter how long or short a time has passed since someone self-harmed, smoked a cigarette, or took a drink or drugs, it’s worthy of respect, recognition, and celebration. Every day safe or dry or clean is a victory.

Aimee uses the tally and day counter app Teal to track her progress, and shared milestones with me from time to time. I celebrated with her on each occasion, recognising the effort it took and its significance. To me, each milestone is equally important. I’m as proud of her for staying free of self-harm for 365 days (and counting) as I was when it was one week, or ten days, or a month. In a few months, another friend will be three years free of self-harm. That is no more (and no less) an achievement as Aimee’s one-year milestone, or someone marking their first day of safety or sobriety.

Relapse Is Not Failure

The flip side to celebrating milestones is acknowledging that relapses happen. Making changes is hard, and it’s not uncommon to slip back into unhealthy patterns. It’s natural to feel you’ve failed yourself and others if that happens, but I’ve never felt my friends have failed themselves, or me, or anyone else. Quite the contrary. It takes enormous courage to acknowledge you’ve resorted to behaviours you’re trying to leave behind, to pick yourself up, and continue the journey. That’s the hallmark of a hero, not a failure.

Sharing Our Stories Matters

On a work call the other day with fellow Mental Health First Aiders, I mentioned that my friend had marked one year free from self-harm. It led to a couple of them sharing their stories. It was a telling reminder of how many of our friends, families, and colleagues deal with such things, or have done in the past. One colleague described how she successfully broke a long-term smoking addiction following a programme described by clinical hypnotherapist Max Kirsten.

Another shared how she used to self-harm on a daily basis because it was the only thing that helped her handle what she was dealing with at the time. I thanked them both for their honest and openness. For me there’s nothing as compelling as hearing someone tell their story. That was the motivation for the books Fran and I have written, and it’s the motivation for every article published on our blog.

Feed Hope Always

The stories my friends and colleagues shared were sometimes painful to hear but ultimately hopeful. No matter how difficult the journey may be, and despite setbacks and relapses, there is always hope. That said, success is by no means certain or necessarily permanent. Lacking lived experience I can only relate what others have told me, which is that you never completely recover from self-harm and addiction.

One friend said she feels she’s unlikely to resort to self-harm in the future because she’s developed more healthy coping strategies, but she can never be certain something won’t happen to overwhelm those strategies and push her towards self-harm again. Staying safe is a matter of ongoing vigilance.

Recognising this places a responsibility on all of us, to feed hope, and support others on their journey. Self-harm and suicidality are different, but as Fran and I describe in our book, we all have the capacity to help keep someone safe — or not.

Fran distinguishes suicide interrupters, “those who are able to defuse the suicide bomb,” and suicide aggravators. The latter are people who, consciously or unconsciously, impact her so adversely that suicide seems a viable choice.

A careless, ignorant, or judgmental remark can have consequences long after we’ve forgotten what we said. In a recent tweet, Aimee recalled how badly she’d been affected in the past by someone saying she would continue to self-harm. This person’s lack of belief in her potential for recovery led her to lose faith in herself. Fortunately, she was able to change her perspective. One year on, her success is a testament to her courage and determination. As she rightly said, “How wrong did I prove him?!!”


Announcing her achievement on Twitter, Aimee invited her followers to imagine it was a year ago and they could give themselves one piece of wisdom or advice. I would tell the Marty of a year ago to take nothing for granted and to fight with all he has for the people who mean most to him. And above all, to remember to include himself in that list.


Mind self-harm page, with links to organisations including Harmless (user-led organisation that supports people who self-harm, and their friends and family), LifeSIGNS (user-led self-harm guidance and support network), National Self Harm Network (NSHN), and Samaritans.

NHS addiction page, with links to addiction services and help dealing with drug addiction, alcohol addiction, smoking and gambling.

NHS drug addiction: getting help.

NHS self-harm resources page, with links including Self Injury Support webchat (women and girls), and CALM webchat (men).

NHS quit smoking page.

Scottish Association for Mental Health (SAMH) page on self-harm.

The Truth About Self-Harm, leaflet (PDF) by Mental Health Foundation.

International helplines, suicide hotlines, and crisis-lines hosted at

For further information including help and crisis lines, see our resources page.


Photo by Fauzan Ardhi on Unsplash