If you suspect the person you are worried about has a MH issue you may be able to convince them that they need a doctor’s support. But it is important not to put a label on these changes too quickly or without professional help. This can cause misunderstanding and complicate an already tricky situation as well as possibly being quite wrong.
There follows a brief description of the major diagnoses.
Symptoms include low energy, waking early or struggling to sleep, finding it hard to get out of bed, eating a lot more or a lot less. People lose interest in things that used to be enjoyed, and are hard to motivate and impossible to cheer up. There is no magic line between a diagnosis called depression and the day to day lows we all experience except a matter of degree. If it lasts a long time and affects the person’s life seriously enough that they need
help from a doctor it can become a formal ‘label’. For many depression can be temporary or mild and only a passing cause for concern. For some it can be severely disabling and long term. It may be in response to a life event or appear out of nowhere. It has been described both as
‘like having your head in a goldfish bowl, you can see the world but not take part in it’,
‘the opposite of rose coloured glasses, everything is grey’.
About one in 20 people will experience it at some stage.
New mothers may feel mild depression or completely overwhelmed, sometimes becoming very ill, possibly because of physical changes although the birth experience and the support available may contribute to the problem.
It can be tempting to feel people are ‘putting it on’ and of course this is possible. But for most sufferers it is not an option and is very unpleasant and frightening. Most people would definitely not choose to feel like that. Like many MH diagnoses, depression is thought to have a genetic component but is often it a response to a life event as well.
Seasonal Affective Disorder (SAD) is the experience of depressive moods during the shorter days of winter and often includes craving carbohydrate based foods. SAD relates to lack of daylight and can respond well to light treatment. In Northern Finland 9.5% of people experience this unpleasant response to winter.
Enthusiastic encouragement to ‘stop feeling depressed and do something positive’ will probably not result in change, but sensitivity is much appreciated even if the person cannot express their thanks until they feel better. Gentle support to try small challenges can be effective but if your cajoling, bribery, persuasion, ultimatums, pleas and patience are not having any effect then maybe there is nothing you can do for a while but wait.
Anti-depressants can be highly effective for many people and provide short or long-term relief. The Chance to talk to someone such as a counsellor or therapist or learning self-help techniques may also be very useful.
Many people worry a lot but at its worst anxiety can severely affect the way someone lives. If you consider what it would be like to have to face something you are really frightened of, such as putting your hand in a tank of snakes, it is a small insight into their constant tension.
Anxiety produces a physical reaction with rapid breathing, palpitations, nausea, sweating and sometimes chest pain. Anxiety disorders can take different formats, the main categories being:
Panic disorders where extreme fear suddenly takes over a person, they may feel they are having a heart attack because of the overwhelming physical symptoms. This traumatic experience can lead people to avoid any situation similar to that in which the panic occurred, which then affects their ability to function day to day.
Phobias are the avoidance of specific situations or objects. Many people have a fear of something (heights, spiders, snakes) but for some it is a constant dread and they will avoid any situation that risks being close to the ‘trigger’ object. Fear of vomiting may lead to difficulties in eating well, not all phobic objects are easy to avoid.
Social phobia is a common anxiety. This is a fear that they will do something inappropriate or embarrassing which will result in humiliation. This is based on an expectation that other people see them as odd, unworthy or stupid.
A woman is taken ill on her way home from the shops; she experiences both sickness and diarrhoea in her own street. She is panicking and unwell but eventually makes it home. The memory is so unbearable, the fear of it recurring, the embarrassment that she might have been seen, that she feels terrified about going outside. So she stops going out altogether and becomes dependent on her family. This in time then becomes a hard habit to break even though the original memory fades.
Agoraphobia is the term used for a fear of being in a place where there is no escape, such as a crowd, a shop, a bus or a queue. The person feels unsafe and may also fear a panic attack.
Generalised anxiety disorder describes a constant state of anxiety which can be focussed on a constantly changing variety of things such as money, health, traffic accidents or their children’s wellbeing.
Obsessive compulsive disorder has two elements. Obsessions are the constant unwanted thoughts that predict that the person will do something terrible or something awful will happen to them or their loved ones. The most common obsession is that they will contaminate others.
Usually these terrible fears are linked to compulsions, which are behaviours that try to reduce these threats. This may be a mental or a physical ritual such as counting, putting things in order, cleaning themselves and/or their surroundings or checking that things are exactly as they should be.
Post traumatic stress disorder is a response to a highly traumatic event, (which may have been apparently coped with well at the time). People may develop periods of intense fearfulness which involve having ‘flashbacks’ of the event in nightmares or in thoughts and images that they cannot control. They may go to great lengths to avoid anything that might remind them of the trauma and become cut off from those around them who ‘cannot possibly understand’. They may also feel very jittery and jumpy, constantly alert for danger and unable to sleep well. They experience the physical symptoms of anxiety for prolonged periods which is exhausting. This may also produce irritable and sometimes aggressive behaviour. This anger can be directed towards others or themselves. Using drugs or alcohol to cope with these issues is also not unusual.
Eating disorders are often anxiety based but because of the complexity and risk to physical health it is vital to get specialist advice. ‘B-eat’ are one of the leading organisations, helpline 0345 634 1414 or www.b-eat.co.uk
Generally medication may help with anxiety issues but mostly treatment is through talking therapies. This tries to break the cycle of having a thought (everyone thinks I am stupid) which creates a mood (fear and self-loathing) and reacting to it in an unhelpful way (so I have to stay at home all day so they don’t see me). This is called ‘changing negative thinking patterns’ and is the basis for cognitive behavioural therapy (CBT).
There are lots of self-help strategies including relaxation, breathing control and yoga, meditation and mindfulness. These are readily available and can be really helpful- but it is never easy to change. As a Carer it may help to consider how easy you have found changing your own unwanted habits!
Supporting someone to change is a delicate process, often including everything between ‘nagging’ and ‘giving up on them’ and patience can be hard to maintain over weeks and months when progress seems slow.