Stress and Mental Illness: Are They One And The Same?

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In my previous post I discussed Is Stress A Trigger For Mental Illness? In this post I’m hoping to highlight how stress and severe mental illness are not one and the same.

We all go through periods of stress, where we feel run down, overwhelmed and generally feel like we need a reset button for life. It does have an impact on our mental health, but it isn’t a mental illness.

I have worked with colleagues that have misinterpreted my mental illness as stress, or the more important distinction that I couldn’t handle stress. Comments such as,

“Well, some of us can deal with stress better than others.” and “At least I’m here all the time unlike some people who are always signed off with stress.” Stress was a trigger for my mental illness, bipolar, and yes, I did have to take time off work because of it. It didn’t mean I couldn’t handle stress, it meant I had a severe mental illness that had not been properly diagnosed, or been provided with the proper treatment.

How we effectively deal with stress can be managed through self care techniques and adapting our work/life balance. If someone starts to show signs of mild to moderate depression or anxiety they can seek help such as CBT or other forms of therapy for a short period. Severe mental illness on the other hand, needs much greater intervention. A psychiatrist, hospital admissions, long term medication and therapy. Significant lifestyle changes such as cutting out alcohol may be not advised, but desperately needed. Can you see the difference? Stress in our lives can be managed, if we want to do so; mental illness cannot. Your lifestyle is a choice, mental illness is never chosen. I think it’s important here to highlight one glaringly obvious cause of stress; poverty. This can’t be eradicated by a simple change in lifestyle by the individual. It’s society at large that needs to work towards this. Is there a difference between the stresses of the upper and middle classes and those living in poverty? Yes, I believe there is. Are those in poverty more likely to have a severe mental illness? Again yes. According to the Mental health Foundation,

“Poverty increases the risk of mental health problems and can be both a casual factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic and physical environments in which people live.”

Many people with severe mental illnesses also fall into poverty because of being unable to work. This exacerbates already difficult to manage conditions and leaves the individual extremely vulnerable to self medicating, self harm and suicide.

When many people speak up about mental illness, often it’s from their own experiences. That’s fine, but when it’s highlighting stress and lumping it in as a mental health condition, it devalues the impact of severe mental illness. Bipolar, BPD, PTSD, Schizophrenia to name a few are long term, life altering conditions that need psychiatric intervention and expertise to assess, treat and manage. Stress is damaging, physically and mentally I’m not denying that. I feel though that there needs to be more room for conversations surrounding severe mental illness. Too much noise is made around stress, and mild to moderate mental illness. Already sufferers feel marginalised and isolated in society and need more spaces where their voices can be heard.

Talking About Mental Health Is Vital, But It’s Not Enough

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I often find myself saying,

“Talking about mental health is so important.” and “Just be open and honest and you’ll feel so much better!” I have done so many times on this blog.

But in my heart, I know it’s not enough. So many of us are being let down again and again. Services are spread thin and desperately underfunded. Recent reports that young people are being denied care until they’re at crisis point, and receiving little to no help unless they have attempted suicide, is disgraceful.

We do need to talk about mental health. Talking can save lives, but our friends and family are not experts. There is only so much that they can do to help and often unfortunately, it’s not enough. It puts a strain on our relationships which can further the isolation and hopelessness of our situation. I’m lucky enough to have a supportive family and group of friends. I do what I’ve been told helps; to talk. I’ve been talking and reaching out for years, but it’s not always enough.

I’ve sought professional help when I’ve contemplated suicide. I was given a number for the crisis team if ever I needed them. I was told they were available 24 hours a day and would help. I’ve had very different experiences to what I was told I would have. After the phone call I wished I’d never picked up the phone. Firstly, I was given the wrong extension number, and then when I finally got through to speak to someone they simply said,

“Carry on taking your medication and you’ll start to feel better soon.” I talk more about this in the post My Experiences of Mental Health Crises Care

GP’s need more training to identify severe mental illnesses and provide the correct referrals. I like many others with bipolar were misdiagnosed countless times, and it took 12 years for me to be diagnosed. Therapy needs to be far more accessible and not just a one size fits all solution on the NHS. Talking therapies is not always provided by a trained psychologist. In my experience it was a counsellor, who had been trained in basic techniques in order to provide talking therapies. It wasn’t enough and he wasn’t prepared to deal with the symptoms I was displaying. Specialist, long term therapy is still out of reach for many. The price tag attached is as if it’s marketed as a luxury rather than a necessity for those with severe mental illness.

Mental health has had budget increases, but they’re far smaller than budgets for physical health. It’s been five years since the government pledged to create “parity of esteem” between NHS mental and physical health services. People are suffering and we demand better. We need to recognise the role of poverty and discrimination in determining access to formal mental health services. We need to address the reasons why so many people from ethnic minorities, the LGBT+ community and those with disabilities suffer from mental ill health. There are still disgustingly long waiting lists. Having an assessment due in eighteen months when you’re suicidal is not only callous, but negligent. Still we’re seeing mental health services strained to their limits. Still people are told,

“You’re not ill enough” and “Come back when you’ve attempted suicide” Change is desperately needed right now.

In the end investment, not rhetoric, is needed to save lives.

 

Is Stress A Trigger For Mental Illness?

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For me, the answer is yes. However, it’s not the cause of my mental illness but a trigger for an episode of bipolar mania or depression. It’s usually coupled with other triggers such as; a lack of sleep, drinking alcohol, or not taking medication.

I’ve been through many occasions where stress has had an impact on my mental illness. When the pressures of work have become too much, I find myself spiralling. The most likely repercussion is an episode of mania. The stress will disappear and I will become a whirlwind of energy and activity. Misdirected this energy can lead to reckless behaviour and I’ll find myself in dangerous situations. Mania also leads to obsession. Either with my work, with colleagues I dislike, or on projects in my personal life. I talk about one example in detail in the post Unhealthy Obsession

Often I don’t realise I’m stressed until I start showing signs of mania and then at that point I don’t care that stress has caused me to feel so euphoric. Of course with bipolar, being so hyperactive and full of relentless energy, I have to come down sooner or later. I talk about this feeling in the post The Mania Hangover . Then the stress I’m under really hits me, as I fall into a depressive state. There have been many times when for whatever reason I am already manic or depressed when a stressful situation pops into my life. Depending on the type of episode I’m experiencing, my reactions and ways of coping will differ dramatically.

Although stress can make us feel ill, a mental health condition has to already be there, whether it’s known to you or not, to trigger a mental illness. We all go through times of stress where we feel run down, lacking energy and generally feel overwhelmed by life. If you’re susceptible to depression or anxiety, the stresses of life can definitely trigger these. I find with bipolar disorder, which I continually live with, stress exacerbates the condition. I’ve learnt that I have to manage the stressors in my life and face up to the causes. Whether that be my job, a relationship, or money worries I need to assess the impact they are having to my stress levels, and ultimately my mental health.

Workplaces in particular need to work with individuals to create an environment that eases daily pressures. Society needs to be more compassionate and provide aid to those struggling for money and living in poverty. I grew up in a household where both my parents worked, yet we struggled financially. I know firsthand as a child and then as an adult how much stress is caused every month when bills are overdue and you have no way of paying them.

If you go through stressful situations but don’t have a mental illness that’s great! But don’t judge those that do. It doesn’t make the person weak or less resilient because stress triggers their mental illness. In times of extreme stress those with mental illnesses suffer; it’s unavoidable.

 

How to Approach Your Doctor If You Think You May Have Bipolar Disorder

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Bipolar disorder takes a notoriously long time to diagnose, on average ten years in fact. Add to this that people with bipolar disorder are misdiagnosed three times on average, it can feel to many like a hard slog to finally receive a diagnosis. This happened to me, where it took twelve years to be diagnosed and I was misdiagnosed with depression several times. I don’t want to see anyone else go through this unnecessarily, so I’ve listed below what you can do before and during meeting with a GP.

Keep a Mood Diary

This is the number one thing I wish I’d done before seeing my GP. Keeping a mood diary for a few months, will give them a picture of how much you are struggling and the stark contrast in your moods. It can be difficult to explain how much your moods are impacting your life and keeping a diary of them is a definitive way to show them this. You may be thinking three months is a long time to wait before seeing a doctor, but believe me three months is better than waiting another three years or longer for a diagnosis. Entires don’t have to be long, you can make bullet points explaining you mood that day. Bullet points will make it easier for the doctor to read through.

Ask For a Double Appointment

Most doctor’s surgeries will have the option of making a double appointment. These are reserved for people with more than one ailment to discuss, or those with more complex needs. An average appointment is only ten minutes and can go by in a flash if you’re feeling mentally unwell and struggling to explain yourself. You may feel rushed and forget what you wanted to say and giving a clear picture of your moods is a vital step in receiving a diagnosis.

Write Down What You want to Say

As I’ve already said, feeling mentally unwell can make us forgetful and/or anxious, stopping us from explaining ourselves fully. You can’t show a doctor a mental illness; unfortunately we can only rely on what we say. Write down what you’re going to tell your doctor before the appointment. It will make it clearer in your mind what you need to explain and highlight important points. Take it with you and refer to it if you can’t remember what exactly you were going to say. If you’re feeling extremely anxious or upset and feel you can’t speak clearly enough, give your notes for the doctor to read themselves.

Take Someone With You

Taking a partner, family member or close friend will take the pressure off you during the appointment. Someone that knows you well and what you’re struggling with, not only provides you with much needed support, but can corroborate your symptoms. A doctor will be more likely to take your concerns seriously if someone with you is agreeing that they have witnessed your extreme moods and unusual behaviours. Their insights may provide information that you can’t, such as how your moods and behaviours are affecting those around you.

Be Assertive

This is a difficult one, but something I feel is important. You know how you’re feeling and how your symptoms are affecting you and you need to make this clear. Often those with bipolar disorder before they are diagnosed are misdiagnosed by doctors with depression and anxiety. In a short appointment a doctor may assess you as having depression as it’s the most obvious answer and much more common. If you feel something else is happening, and you’re struggling with manic, psychotic or other symptoms, you need to tell the doctor. Being assertive doesn’t mean you have to be aggressive or confrontational, only making your points confidently and articulately.

A good doctor will take the time to speak to you, and check your medical history. Your medical history may highlight patterns of earlier mental illness that link to signs of bipolar disorder. If your GP agrees with you this will lead to a referral for a psychiatric assessment. The assessment will be much more in depth with a psychiatrist and will give you a clear answer as to whether you have bipolar disorder or not.