There should be no shame attached to looking after our psychological wellbeing, just as we look after our physical health, writes Rachel kelly
For the past five years, I have spoken publicly about my own recovery from severe depression which in the past saw me hospitalised.
As a former Times journalist, who was married to a banker at Goldman Sachs, I have found that my own story resonates most strongly with others from a professional world. The bankers, lawyers, and high profile business people I speak to recognise the pressures I felt as someone working long hours in a newsroom, answerable to a news editor at ten o’clock at night if I missed a big story.
They too know what is like to be well-paid, to enjoy all the privileges of a professional lifestyle, with the house and the holidays, but privately to feel overwhelmed.
A few confide me at the end of my talks that they too feel close to breaking point, unable to keep up with demands at home and at work. They long for change, but are too frightened to step off the treadmill given their mortgages and the drum beat of the school fees.
Those from privileged backgrounds are a second group who nod most in agreement when I share my view that a privileged life does not guarantee a privileged health. They tell me how challenging it is that others think they have nothing to worry about, such is their bank balance.
Despite all the evidence to the contrary, the assumption is that high net worth individuals enjoy good psychological health as a birthright. In fact, very often wealth, especially inherited, can lead to the lack of purpose and sense that there is no good reason to get up in the morning. In addition, those who live off trust funds feel worthless, and that they do not deserve the lifestyle they enjoy.
When delivering my wellbeing workshops at banks and law firms, I like first to assess how open the audience are about their own mental health. Do they find it easy to talk about any condition they, or their family, have experienced? Can they share their experience of dealing with mental illness, whether it is post-traumatic stress, bi-polar disorder, or anorexia or bulimina?
The good news is that while the stigma surrounding mental health has not completely disappeared, generally it is on the wane. More and more of those I speak to from a privileged background are no longer embarrassed to talk about their psychological wellbeing. Mental health is firmly on multiple agendas. Everyone from the Duke of Cambridge to the Prime Minister talk of the need to look after our mental health.
This is a good thing. Only by talking and being open can people begin to get the support and help they need. Which brings me to treatment, where I am afraid the picture is less positive.
As one battle fades, another emerges: the nature and quality of treatment. You might have thought by now, given the focus on mental illness and the increased government expenditure – the Health Secretary Matt Hancock announced in January this year that the biggest single rise in budgets was in mental health services – that those who suffer would be delightedly discussing their improved care.
Yet I find a widespread disillusionment among those who suffer with the help they are receiving – even the very best private care. The problem is the limitations of the treatments on offer.
For the past twenty years, these have been medication, chiefly in the form of antidepressants, and cognitive behaviourial therapy: a talking treatment which aims to change the way people respond in thought and action to the world. These are the best options we have, but neither are perfect.
First medication. 7.3 million people were prescribed antidepressants in England in 2017, 4.4 million of whom were also prescribed such drugs in both of the two previous years. Millions of people therefore are not sufficiently cured of their mental health problems that they are able to stop taking the drugs.
I’m no scientist and it is not for me to pronounce on how effective various chemical compounds are at producing changes to the brain. Yes, I took drugs and I did recover. Medication may well have been part of that recovery, although we know that a third of people do not respond to antidepressants at all, and some trials suggest that in some cases placebos achieve strikingly similar results to the real thing. But in an ideal world I would rather have avoided the side-effects of the drugs – in my case gloomy-making weight gain.
I found talking therapies easier to accept. Over the years, I have felt warmly towards various counsellors who have tried to help me, talking sympathetically and listening to my problems.
So I was helped by conventional treatments, and my argument here is not to disregard them. But I do increasingly think we need to change the way we think about mental illness altogether. In a nutshell, we need to take more responsibility for our psychological health ourselves, just as we do for your physical health.
Here’s the thing. Mental illness is real. Something goes wrong with our brains. (We know remarkably little exactly what does happen, by the way.) But the illness happens in a context. Why shouldn’t it? If we eat too much sugary food for example, we are vulnerable to certain kinds of diabetes. Equally, if we fail to prioritise our psychological health, we will succumb more readily to depression and anxiety.
This is actually very positive. We can help our minds to flourish, and not just rely on experts, be they psychiatrists or therapists. Neural plasticity means we can rewire our brains and create new neural pathways. I find that so encouraging.
Feeling passive and a victim, and powerless to do anything about my condition, was part of being depressed. This was particularly true when I received a diagnosis. Yes, mental health diagnoses is important, but it should not be an invitation to give up just because you have been told you suffer from a condition. You may be able to learn to manage that condition in such a way you can lead a good life. The more I discovered my own ability to take action to get better by writing my own story, the better I felt.
This insight is the basis for my current approach to managing my own mental health. Every day I remind myself that I can make a difference. This begins as soon as I wake.
The first thing I do is to make my bed, the white duvet perfectly aligned and my pillows plumped. A small gesture to be sure, but one that reminds me that if I take control of small decisions in this way I will feel my own power to affect larger decisions.
Powerful businessmen and women and politicians often adopt these tactics to establish a sense of control when entering a boardroom or unfamiliar environment. They might change the position of a glass, or alter the height of the microphone on a pulpit, or reshuffle the papers in front of them.
In addition, I can take care with the language I use, to others and myself. Instead of saying ‘I’m at the mercy of my anxiety’ I might say ‘I can choose how to respond to my low mood’. Or instead of saying ‘I can’t deal with this stress and worry’, I might say ‘I can’t deal with this stress and worry yet.’
My belief that people need to develop a sense of agency and empowerment about their mental health has led to my first workbook for people to complete to help them thrive rather than just survive. Singing in the Rain: 52 Practical Steps to Happiness has evolved with the help of many others, both mental health nurses, psychiatrists, therapists and psychologists, but also those who come to my workshops.
Together we have developed practical steps of stuff you can do. Thinking often makes me sad, but doing rarely does. The workbook is about action, full of accessible activities, one for each week of the year, to help you rediscover your own ability to thrive. There are easy to follow exercises and puzzles, from how to deal with difficult conversations to writing a letter to your difficult feelings, all based on numerous psychological studies.
It was lovely to see a new energy in the workshops when people believed there was stuff they could do on their own. By completing the workbook, they became engaged and enthusiastic about their own ability to affect their mental health in a new way.
I’ve seen the difference over the weeks and months with those I work with when attendees believe they can make a difference. As they make small changes, they feel more in control and therefore less stressed and depressed.
Just as our attitude to stigma has changed since I became involved in the field of mental health, my hope is that in the future we will demand more of treatment too. We need better and more effective drugs, more access to counselling, and more research into the lifestyle changes that make a difference, embracing as I have done, everything from nutrition to bibliotherapy. Above all we need to remember a sense of our own agency and autonomy. There should be no shame attached to looking after our psychological wellbeing, just as we look after our physical health. We might even find ourselves singing in the rain.
Rachel Kelly is a writer, and mental health campaigner. Her latest book Singing in the Rain: 52 Practical Steps to Happiness is published by Short Books, £12.99 and is available in Waterstones and Amazon