Occasional Spikes of Mayday: The Power of Analogy When Talking About Mental Health

Fran and I find analogies helpful when discussing mental and physical health. This is especially true when one person has little or no experience of what the other is attempting to convey. In this post I want to share a few models and analogies we find useful, and introduce a new one we’ve only recently taken up. I’ve described a few of these previously in The Stress Bucket and Other Models That Help Me Talk about Mental Health.

Spoon Theory

Perhaps the most well-known analogy for chronic illness is the spoon theory created by Christine Miserandino. The idea is that people living with energy-limiting conditions such as MS (multiple sclerosis) and fibromyalgia begin each day with a limited number of energy units, represented by spoons. If you’ve ever come across the terms spoons or spoonies online in a health context, that’s what they’re talking about.

Waves

Although Fran and I reference spoon theory on occasion, we’re more likely to employ our home-grown models. I’ve always loved the sine wave analogy Fran employed on a TV interview to describe her symptoms.

My chronic fatigue syndrome operates like this ... [Fran draws an up and down sine wave in the air.] My bipolar depression operates like this ... [She draws a second wave.] And sometimes they go like this ... [She draws two synchronised waves.] And sometimes they go like this ... [Fran draws two waves out of phase, so that one peaks while the other bottoms out.] It’s really quite a bizarre experience.

In those few sentences Fran captured for me the essence of a life lived with distinct but overlapping health conditions. As we describe in our book, waves also feature in the model a friend of ours uses to explore her relationship with depression.

My analogy is a sunny beach. The sea represents my depression. If I’m in the water out of my depth I’m not feeling so good. If I’m knee deep I am getting better. If I’m walking on the beach with waves lapping at my feet it’s much better. If I’m on the dunes looking back at the sea view at sunset I am happy and content, at peace for a while.

No one can hold back the tide of illness by willpower alone, but the clarity of our friend’s model acknowledges a degree of personal responsibility.

Flatness

Analogies also serve as a form of verbal shorthand for thoughts and feelings that might be difficult to express in detail. In Flatness and Disinclination I described how I use “flat” as shorthand for a sense of feeling low. “Not actively low or depressed; it’s more like the absence of any specific emotion than the presence of a negative one.” I can use the term with Fran or other friends to let them know how I’m feeling without having to go into details. This is especially helpful to me because I find it extremely difficult to label my feelings and emotions, a key indicator of alexithymia.

The Box on the Shelf / Waterfalls

Other analogies of ours include The Box on the Shelf for handling difficult issues or situations, and the analogy of a waterfall which relates to holding space for other people.

I thought for a moment about the term holding space. We use it a lot, but I’d never really considered what it means. “The idea,” I continued, “is to hold a space open for everything that’s being shared to flow into.”

I offered an analogy. “Imagine you’re standing beside a waterfall. If it’s a small waterfall with a small pool, you can stand close by. If it’s a big waterfall it will have a bigger pool and more spray and splashing. You would stand further back so you can appreciate it without getting wet.”

The waterfall analogy is about maintaining healthy boundaries, and is one we reference on a regular basis.

Air Traffic Control

I recently shared a blog post about air traffic control (ATC) as an analogy for aspects of a supportive friendship. As I wrote in Squawk 7700 “The radar analogy is a useful addition [to my toolbox]. Like an air traffic controller, I scan my collection of friends to see how everyone is doing, and to make sure no one gets left out or forgotten about.”

Plate Spinning / Mayday and Pan Pan

For a long time, Fran has been advocating for her elderly parents. This can be both mentally and physically draining, not least because things seem to transition from one crisis to another with little intervening respite. It can be difficult for Fran to prioritise the different items that need addressing or following up. During a recent conversation I reminded her of the plate spinning analogy I’ve found helpful when similarly overwhelmed. I’ve described this previously in How I Keep My Plates Spinning (Mostly).

I’ve focused on how I keep my plates spinning, but sometimes there’s just too much crockery up there! It’s more graceful to catch a few pieces before they fall and set them safely aside, but it’s okay if one or more end up on the floor. Maybe we took on too many tasks at once, either because we overestimated our capabilities or because we were given little opportunity to say no. Maybe we tried to handle just a little too much drama, our own or other people’s. Maybe life simply threw more at us than we could ever hope to keep going at the same time.

I also offered a new analogy rooted in my fascination with aviation. Mayday and Pan Pan are internationally recognised distress calls used by aviators to alert air traffic control to issues they’re dealing with. Mayday is used where there’s an imminent and serious threat to life or the aircraft. Pan Pan is a lower level alert. It’s used for situations which are urgent but not immediately life-threatening. In each case there are defined procedures for both aviators and ATC so that the situation can be resolved as safely as possible. In the case of a Mayday call, the aircraft will be afforded immediate and full attention of all relevant emergency and support services, with other aircraft and airport movements being adjusted or suspended as necessary until the crisis is over.

I asked Fran what kind of alert she’d issue for how she was feeling. She said she’s been living in a pan pan scenario for a long time, “with occasional spikes of mayday.” It’s not that I was unaware of how things had been for her. We talk every day about whatever’s going on for both of us. But those few words — using an analogy which I’d offered her because it resonates for me — conveyed the reality of her situation in a way I could immediately appreciate and understand. It was a great example of the power of analogy in helping us understand what’s going on for someone else, and in sharing how things are for us.

Over to You

In this blog post I’ve described a number of models and analogies which Fran and I find helpful when we’re discussing aspects of mental and physical health. Do any of them resonate for you? Do you use analogies to help you describe your symptoms to friends and loved ones? Do friends and loved ones use any when describing their situation to you? Which do you find most useful? Are there any you feel are unhelpful because they trivialise or gloss over the details? We’d love to hear your thoughts, either in the comments below or via our contact page.

 

Photo by Camilo Jimenez at Unsplash.

 

The Stress Bucket and Other Models That Help Me Talk about Mental Health

Talking about mental health can be difficult and I wrote recently about some of the reasons we may not want to. Part of the problem can be that we lack the words to adequately describe what’s going on for us when we’re struggling. I was reminded of this a few weeks ago when I completed a Mental Health First Aid Refresher course. The training covered several models of mental health and wellbeing, including the mental health continuum and stress container (or stress bucket). Models such as these can never completely describe the personal and often subtle details of what we’re going through, but they can provide a starting point and some common language with which to explore and share our feelings. In this article I’ll cover a number of models I find helpful when talking about mental health, plus two relating to supportive friendships.

The Stress Bucket

Also known as the stress container this model was originally developed in 2002 by Professor Alison Brabban and Dr Douglas Turkington. There’s a useful overview in this article on managing stress published by Lincoln University.

When we’re stressed it’s natural to focus on the events, situations, and triggers that led us into that state. These stressors can be difficult to avoid or eliminate, however, leaving us feeling hopeless or overwhelmed, with no option but struggle through as best we can until — hopefully — things ease up. The stress bucket model reminds us we have other options.

The model invites us to imagine we each have a stress container or bucket. The size of the bucket varies from person to person, and can also vary from time to time throughout our lives. Stressful events and situations flow into the bucket, starting to fill it up. These stressors might include problems with our relationships, friendships, work, or money; anything that adds to our feeling stressed and anxious. If we have a relatively large bucket, it might take a while before it starts to overflow, but no matter how small or large it is, our bucket will fill up unless we do something about it.

The most obvious approach is to address the source of the stress. If we can resolve the issues then the flow of stress into our bucket will reduce or stop altogether. That’s not always possible, though, at least in the short term. And even if we resolve one stressful situation, there’s likely to be another potentially stressful situation not too far behind. It’s possible to become more resilient, which we can think of as increasing the size of our stress bucket. Without being able to let stress out, though, any size bucket will fill up eventually.

We can let stress out in various ways. Think of this as making holes in the bottom of the bucket, or opening taps to let the stress out. Healthy taps include exercise, meditation, journaling, listening to music, or spending quality time with friends; anything that helps you relax, de-stress, and regain a sense of balance. Less helpful strategies include excessive use of alcohol or drugs, or attempting to ignore or avoid the issues. These may provide temporary relief but tend to feed additional stresses back into our bucket.

I like this model because it helps me focus on what I can change, and how I can best manage stressful situations without becoming overwhelmed or resorting to unhealthy coping strategies. I particularly like the taps imagery. It reminds me I can choose which taps I want to open, how much, and for how long. My taps include journaling, blogging, and spending time with friends.

Spoon Theory

Spoon theory was coined by Christine Miserandino in an article first published in 2003 at But You Don’t Look Sick. The article recounts a conversation with a friend in which Christine shares her experience living with lupus. She passes her friend a handful of teaspoons and explains that each spoon represents one unit of energy which must be relinquished as she goes through her day-to-day activities. The limited — and fixed — number of spoons reflects her need to continuously monitor her resources and manage her activities accordingly.

Although originally devised to explain what it’s like to live with the autoimmune disease lupus, spoon theory has been adopted by people living with a wide range of chronic physical and mental health conditions, characterised by limited resources of energy and focus.

It reminds me that activities that require little advance thought or planning for me, such as cooking a meal or taking a shower, might place major demands on someone who lives with illness or disability. It’s more than simply feeling tired. Someone with few remaining spoons for that day has to mete out their resources with extreme care. They might need to forsake activities or cancel arrangements in order to accomplish tasks that are more important or essential.

Although I wasn’t aware of spoon theory at the time, I recall Fran describing what it was like for her to try and make a sandwich when in the midst of a crushing depressive episode. “Oftentimes,” she said, “I would only get as far as opening a can of tuna and eating it from the can rather than bothering with getting mayonnaise and bread, to save the energy needed to wash the dishes. All energy had to be minutely calculated.”

Sine Curves of Mood, Pain, and Energy

Fran and I describe several models in our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder. One I’ve found especially helpful originated in an interview Fran gave on TV before we met. In conversation with Jennifer Rooks on MPBN, she described the ever-changing nature of her illnesses.

My chronic fatigue syndrome operates like this . . . [Fran draws an up and down sine wave in the air.] My bipolar depression operates like this . . . [She draws a second wave.] And sometimes they go like this . . . [She draws two synchronised waves.] And sometimes they go like this . . . [Fran draws two waves out of phase, so that one peaks while the other bottoms out.] It’s really quite a bizarre experience.

We’d been friends no more than a few weeks when I first watched the interview. Fran’s simple analogy of interwoven waves of pain, fatigue, depression, and mania helped me grasp what it’s like for her to live with multiple, independent yet overlapping, illnesses.

Waves on the Shore

Waves of a different kind feature in the model another friend uses to explore her relationship with depression. As she described for our book:

My analogy is a sunny beach. The sea represents my depression. If I’m in the water out of my depth I’m not feeling so good. If I’m knee deep I am getting better. If I’m walking on the beach with waves lapping at my feet it’s much better. If I’m on the dunes looking back at the sea view at sunset I am happy and content, at peace for a while.

The imagery reminds me of King Canute who demonstrated to his fawning couriers that he had no power over the incoming tide. Like Canute, our friend knows she cannot hold back the tide of depression by willpower alone. Her model nonetheless shows how important it is to take responsibility for what she can influence. She can alter her situation by swimming for shore or stepping onto dry land. In practical terms, this might mean changing aspects of her lifestyle and behaviour, taking prescribed medication, or employing therapies or other coping strategies.

Relentless Army Model of Suicidal Thinking

It can be difficult to convey what we’re going through to someone with no equivalent experience. I’ve never been suicidal but Fran described one aspect of her suicidal ideation in ways that I could understand.

Fran once described these [suicidal] thoughts as a relentless marching army. Each thought must be acknowledged individually, picked up, and set aside before she can take on the next. The assault repeats again and again, sometimes for hours. It is exhausting, and the danger is that weariness and desperation may lead Fran to harm herself, if only to stem the onslaught.

On other occasions she likened her experience to playing the video game Space Invaders, where the goal is to shoot down wave after wave of advancing aliens. It’s a powerful analogy, the difference being that failing to defeat the army of dangerous thoughts could cost Fran far more than a lost game.

Return to Down: My Baseline Mood Model

So far, I’ve described models which help me appreciate what it’s like for other people. What about when I want to talk about how things are for me? I’ve shared a few personal models and analogies here on our blog. One of the most helpful arose from an insight I had about my baseline mood slipping from positive to low.

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.

There’s a parallel here with the rubber band analogy Fran uses to describe the “rebound crash of pain and fatigue” she experiences with her fibromyalgia if she exercises or exerts herself too much. I’ve yet to fully work through what it means for me, but it helps me navigate some of the (occasional) ups and (more persistent) downs I experience. It’s also helped in describing how I’m feeling to other people.

Two Models of Friendship

Our books and blog focus on mental health and supportive friendships. It’s no surprise, then, that I’m interested in models that relate to personal relationships. I’ll close with two I find helpful when working through issues with friends or exploring my need for connection and support.

In Dissolving the Circle I described my former model of friendship: an inner circle of close friends but almost no one outside of that circle. This served me for many years but led to a situation where I found it difficult to make new friends or handle the loss of people from within the circle. It took time but I eventually managed to dismantle that model and arrive at something much healthier.

In my world now there is no Inner Circle: just me and — everybody else! Of course, some people are closer to me than others, some relationships are stronger than others, but there is no circle, no event horizon. It’s been a revelation. Everything is dynamic, rich, colourful. And I feel free. I am free. I’m free to strike up a conversation one day with someone at the next table to me in a cafe, who seems to be having a rough time. I’m free to chat holiday plans with a couple I bump into most weekends. I’m free to sign up for a course without stressing that I won’t know anyone or whether I will be able to engage. I’m free to meet a new friend for coffee, to enjoy her company and the conversation, and for us to part without needing to know when we will next get together.

I explored supportive friendships in more detail in Spokesfriends and Insular Groups: What Kind of Support Network Do You Have? The distinction is between having a network of people who mostly know one another (one or more insular groups) and having friends who do not know one another well or socialise together (spokesfriends).

If I drew my network out on paper there’d be a dot in the middle representing me, with lines radiating out to each of my supportive friends, like the spokes of a wheel. [...] This kind of network is more likely if your friends live far apart, as mine do, although that’s not necessarily the case. A few of my “spokesfriends” have met, in person or online, but none of them know each other well or socialise.

In contrast, Fran has several small groups of friends, most of whom live locally to her. Within each group, people know one another and call or meet up more or less regularly. Fran’s support network could be drawn as a number of overlapping circles, plus me and a couple of others who aren’t in any of her groups of mutual friends.

It’s not a question of one type of network being better than the other, and in practice most people will have a combination of the two types. Exploring the two types of network, though, helps me grasp the different dynamics that can arise within and between friends. It’s a model I’ve used when discussing friendship and support with Fran and other friends.

Over to You

In this article I’ve described a number of models relating to mental health and supportive friendships. Do any of them resonate with you? Which ones and why? What models or analogies have helped you understand your health situation, or that of friends and loved ones? Fran and I would love to hear your thoughts, either in the comments below or via our contact page.

 

Photo by Lubomirkin at Unsplash.

 

Spoonies Online: Friends in Need … but Also Friends Indeed?, by Teresita Bauer

If you are unfamiliar with the term “spoonie,” it refers to an article by Christine Miserandino called The Spoon Theory, in which she describes explaining to a friend what it is like to live with debilitating fatigue. Her spoons analogy has been taken up by many who live with chronic fatigue, whatever its underlying nature or diagnostic label.

Teresita Bauer is a spoonie who, in her own words, lives life to the fullest. She blogs about lifestyle issues for chronic disease patients. In her first guest post for us, she talks about her experience within the online spoonie community.

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Spoonies Online: Friends in Need … but Also Friends Indeed?

The online community of spoonies is a great source of support and information. Have you ever found a friend there? Great! However, have you ever been hurt by someone online, someone you did not even know? Some people have a thick skin. Unfortunately, spoonies tend to be more vulnerable.

Obviously, the spoonie online community offers lots of advantages. You can find support, information, motivation, practical tips and advice there. You meet fellow warriors who are fighting a similar battle. Other spoonies will understand what you are going through. Not necessarily because they care about you, but because they are experiencing the same. You will never walk alone – or lie there alone, if you are bedridden.

On the other hand, online communication is more conflict-prone than offline chats are. Anonymity on the internet brings about behavior which would otherwise be considered socially unacceptable. Most social media users tend to be more impetuous and straightforward. The lack of nonverbal cues and the different possibilities of interpreting written statements add fuel to the fire.

It is one thing to understand these mechanisms and it is quite another to be able to deal with them. I have been hurt. Not once, not twice, but many times. Knowing that sharing my chronic disease experiences with other persons is risky, I have learnt to take precautionary measures.

I am online for advice and help. It should make me feel better, not worse. If it makes me feel bad, it’s time to turn my computer off. I clarify a misunderstanding once, however, I refuse getting into endless discussions. I am always aware that those online friendships which are deepening quickly can rapidly go up in smoke as well.

I rely on people who are there for me; day by day. Yet I select them carefully. Online and offline.

About the Author

Teresita Bauer was diagnosed with leukemia two years ago during her last pregnancy. She also suffers from asthma and depression. She has decided to live life to the fullest and wants to help others to do so as well. She blogs at www.lifeisanoption.com.