This post follows on from Psychosis and Me, where I touched upon my personal experiences with psychosis. In this post I will break down my phases of relapse and summarise the steps I take on a regular basis in order to look after my mental health, so as to avoid further relapses. I must reiterate that, as well as practicing different self-care techniques, I also adhere to medication prescribed by a specialist. This underpins the management of my mental illness. I will dedicate a future post to the medication I take in due course.
The phases of relapse
Mental relapses often take me by surprise. They can creep up on me like a looming shadow cast from a street light in the darkest hours. They can hit me like a freight train, and seriously impair my daily functioning. Others don’t take me by surprise. The more prepared I am to fight a relapse from occurring, the better the outcome is for me. Relapses occur under different circumstances and vary in extremity. I’d separate deteriorations in my mental health into three phases – mild, moderate and severe.
Mild / early phase
The mildest form would be what I’d call a ‘slight wobble’, or a mild deviation from my regular mood states and thoughts. Arguably these don’t really count as relapses, as they don’t affect my day to day life. These occur when I’m under a particular amount of stress at work, or in my personal life. My sleep may be slightly disturbed, and my mood may temporarily fluctuate one way or the other. I may be slightly more on edge and anxious, but I tend to function very well with this change. More often than not I spot these shifts early. Once identified, I take necessary steps to return my mood and thoughts back to their usual healthy state. If the appropriate steps aren’t taken quick enough there’s a chance that my mental health can worsen. This is why I’ve identified early warning signs.
Moderate / middle phase
If my mental health was to deteriorate further, it would start to have a negative impact on me. My sleep would become very disturbed. My mood would be elevated and my thoughts would be racing and disruptive. I’d be unable to concentrate for long periods of time. Interacting with people would be difficult and going to work would be risky. During a moderate relapse, I am very emotional and vulnerable, and require regular check-ins from those close to me. It is when I reach this stage that I take sick leave from work and become more secluded.
Severe / late phase
During a severe relapse, I become truly psychotic. This is very serious. Historically, I have had to return home to be looked after by my parents. At best, I have fleeting suicidal thoughts and nothing more. At worst, I have devised plans to harm myself with the intention of dying. It isn’t the low mood that forces this motive, it’s the persistent delusions that drive me to the point of self-harm and suicide. During this phase, I have to take one step back in order to go two steps forward. Thankfully I have been able to emerge from the rabbit hole unscathed on almost all occasions. I could not do this if it wasn’t for my friends and family. I also couldn’t re-emerge without putting my mental health at the forefront of my priorities.
I have to put in a lot of work not only during, but in preparation for relapses.
Methods of self-care that work for me
Self-care is very much like the cheesy pre-flight safety instruction: fit your own mask before fitting others. There’ve been many occasions where I’ve put others’ needs before my own, at the expense of my mental health. It’s an easy trap to fall into, especially for those whose job involves directly caring for other people. Ironically, those who spend their lives looking after the sick and vulnerable are often more susceptible to mental illness. I have written a piece about this in greater detail here. I couldn’t do my job day-to-day unless I took responsibility for my own mental wellbeing first. I see it as my duty as a doctor to help others, but living with a mental illness takes its toll. This is why I need to take extra care in my day to day living to be the best clinician I can be. I also help and support those close to me. So by firstly helping myself, I can extend help and support to those I care about.
Self-care is something that is very personal to an individual. Something that works for me may not work for someone else. Here’s a list of activities and hobbies I partake in on a regular basis in order to keep me sane:
Music plays a huge part in my self-care routine. I can’t go a single day without listening to some kind of melody. Listening to music is a form of therapy. It puts me at ease when I need comfort and is a form of escapism.
Not only do I listen to the music I love, I also play a little as well. From the age of seven, I started to learn the classical guitar. For eleven years I attended weekly music lessons, and played consistently throughout my childhood. I still pick up my guitar every once in a while. I play old songs I performed during exams, as well as modern acoustic classics. I have recently challenged myself to learn more songs on the guitar. Although at times I saw it as a chore, playing the guitar has been a significant outlet for me. It was also a means of expression during my childhood, and continues to work as a form of release and relaxation today.
Working a stressful job is draining, not only mentally but physically as well. This is why exercise plays such an important role in my self-care routine. Working out helps keep my brain mentally stimulated and is an outlet for pent up frustrations that can often build during the day. If I haven’t exerted myself for a while, I tend to feel sluggish and anxious. My quality of sleep worsens and this can negatively affect my mental health.
Maintaining good sleep hygiene is paramount to maintaining a healthy mind. This is particularly important with bipolar, whereby sleep disturbance and insomnia are common occurrences. Making my bed, decluttering my room and putting my phone on silent are some of my most basic bedtime habits. However, during periods of high mood and insomnia, things get a little tricky. Being wide awake at 3am is awful, but getting up, checking my phone and thinking about the day ahead doesn’t help. Even if I don’t get a single wink after 3am, I have found that lying in bed until morning proves more beneficial than trying to be active at this time. It helps maintain my circadian rhythm for the following night.
As well as keeping good habits around sleep, I also take sleeping medication. Although not a daily necessity, I take these specific tablets on an ‘if I need to take them – I will’ basis. These medications are also prescribed by a medical professional; they’re not bought over the counter or off the internet. They aren’t perfect, but they definitely help when I need them most.
Meditation and Mindfulness
Several years ago my father introduced me to a self-help, meditation app – Calm. He had heard through his friend how useful it was for keeping a sound headspace. I soon got into using the app and paying an annual subscription.
For me, this app has been life-changing. Amongst several other features, it includes topic-specific guided meditation. The meditation itself took some getting used to, but I haven’t looked back. Although I don’t practice mindful meditation daily, I incorporate mindfulness into my life now more than ever. I find it particularly useful during stressful periods. It provides a foundation for building resilience to life’s pressures. It has helped me stay calm and relaxed in situations where I would otherwise be panicked and stressed. Being mindful is a means of releasing my pressure valve, and has undoubtedly strengthened my mental health.
If I were to break a bone or tear a muscle in my leg, I would need time to recover and heal from my injuries. If I were to start walking again, I would need rehabilitation and to engage in regular exercises to become fit once more. Living with a mental illness and dealing with relapses are hard, but it requires a similar attitude to when a serious injury is sustained. Self-care and relapse prevention are just as important as riding the mental wave of relapse.
Riding the waves
In summary, my mental relapses greatly vary in severity. They can be overwhelming, like a tidal wave with a strong rip that takes me under the surface and pins me down. They can come in smaller waves; ones that I can ride out whilst my feet are firmly planted, keeping my head above the surface. How I ride the wave is dependent on how well I look after myself before, during and after a relapse. If something as basic as sleep takes a hit, my balance unevens and I can be knocked off into the deep. Therefore maintaining healthy habits and a positive outlook allows me to best manage elements that can feel out of my control.