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Stress, anxiety and depression

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Edited by Annie Storkey, Friday, 12 Jun 2020, 11:59

Unless you are someone with a mental illness, it can be difficult to comprehend how stress, anxiety and depression are so intricately linked and why it is so difficult to manage.

Yesterday morning I received a phone call to tell me that a close family relative was seriously ill in hospital. I am very experienced at dealing with anxiety-inducing situations so set about limiting my risks. I contacted my husband so he was aware, fulfilled my duties in contacting further relatives and then looked at my workload. I decided that my marking workload was manageable for the day and that clearing it would be a good move in case I needed to take a break. I kept my evening appointment and informed my manager of my situation. A phone call from another relative late in the evening informed me that the situation was much improved and was no longer as serious as first thought. A win-win for me, you might think, with improved outcome for said relative and mental health well managed.

Except today I have depression. Only mild depression, my bipolar disorder tends to swing its extremes more in the other direction. But depression, none the less, and clearly a response to yesterday. Luckily I am in a situation where I work flexibly so I can take a step back from work temporarily if I wish; other people have a much difficult time without family and work support. But it does make me reflect on the fact that even good management of stresses won't necessarily prevent a poor mental health response. 

A well meaning friend recently said to me that mental health was caused by society and that what is needed was to support people to change behaviours (they also mentioned trusting in God and I pointed out that my mental health has never negatively impacted on my faith, and perhaps the church might approach Christians who have experienced mental health challenges to learn from them about keeping faith when times are hard). But, much as I believe that society does impact on mental health and that behaviour change is important (my doctoral research looks at motivational support for people with mental health challenges), there is a risk in blaming the person here. Behavioural approaches are very helpful, in my experience, but the mental illness is still there and needs managing; it doesn't go away. I can get by without medication as I have an unusually supportive and flexible lifestyle but for many people this isn't a possibility and I think people often underestimate the impact of daily stresses, from minor work or home challenges to the big issues of loneliness. Things build up and even a small thing can trigger a major response. One of my main stressors is conflict as I have social anxiety.

Onwards and upwards. I start the day by giving thanks for the health of my brother and now I'm going to spend some time reading some papers for my literature review.


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Managing lows

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Edited by Annie Storkey, Friday, 12 Jun 2020, 12:07

I openly discuss my bipolar disorder so it sometimes comes up in tutorials when we are discussing health theory or disability. Recently I was discussing the concept of 'curing' in a K219 tutorial and one of the examples being discussed was mental health so I gave my personal opinion. I enjoy the positive reactions I get from students when I discuss my mental health, students are very encouraging on the need to reduce stigma and often come out with their own experiences. Someone mentioned how mental illness can creep up on you and I acknowledged this, pointing out I often don't realise I'm manic until well into an episode, partly because it is enjoyable, and the need to have a confidant who is able to recognise and discuss it with you. A student then said 'What about the lows?' and I realised that I very seldom discuss the lows.

I don't have lows very often, my bipolar mainly features hypomania and I seldom have deep lows since the first ones I experienced when I was first diagnosed 20 years ago. Manic depressives are often diagnosed during a depressive episode, mania can be enjoyable but depression isn't. McKeon (1995) suggests that the first depressive episode is often triggered by emotional stress switching on a genetic mechanism. Mine was triggered by my father becoming seriously ill and almost dying. 

I discussed my mental illness at a church meeting this week and my husband said that he could detect my mood swings and we then worked together on strategies to manage them. Later I challenged him on this; he actually identifies my manic periods but not my depressive ones. Mania is a very public thing, it is outward in its appearance, but depression is quite private and inward. I can't always tell I'm depressed myself until well into a period, it creeps up on you as noted earlier but it is also difficult to tell what normal is if your moods are usually abnormal. 

I've had marking over the last few weeks and I've been prevaricating over it. Now, finding displacement activities to avoid marking is quite normal, I'm sure, for most ALs. But it was when I was crying at the thought of it that I realised that I was depressed not just avoiding work. Recognising it meant I could develop strategies to manage it. Firstly, giving myself very small goals, perhaps 2 papers to do,  to make it manageable. I often find if I set myself to mark 2 papers I actually mark 4 as starting is often the hardest thing and once I'm into an activity it provides a welcome distraction from my emotions. I also prepare myself mentally, physically and spiritually. I make sure I go for two walks a day and get some fresh air and exercise. I eat healthily and take vitamins. I meditate and say a prayer before working (non-religious people might consider an activity such as writing down some positive things to be thankful for and some short term, achievable goals). I take regular breaks and have a cup of tea.

So, why I am I writing this? Well, in my experience, students with mental health challenges often face similar struggles when writing an assignment; it becomes a big wall that seems impossible to get over. As ALs we need to recognise these hurdles are real issues and work with our students to overcome them. Acknowledgement and empathy is the first priority alongside open channels of communication so that students can voice their fears and anxieties; this does much to reduce the burden. Work with students to come up with achievable goals over a period of time, perhaps just listing key points at first, then developing a plan for an essay, then tackling a paragraph a day so it does not become overwhelming. Plan ahead to the next assignment so that they are prepared in advance. Encourage them to look after their physical health too, to take regular breaks and get some rest. Most of all, let them know that you value them and you are on their side, even if their decision is to take a break from their studies. 

Most importantly, listen to their voice so you can empower and support them to achieve their potential in whatever way they can.

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