By Marion Janner
I hope you’ve enjoyed the last few newsletters which are now headed by Star Wards’ new Director Geoff Brennan. Keep an eye out for a new newsletter coming very soon. Since handing over to Geoff in January from my very active role with Star Wards, I’ve been reflecting on the wonderfulness of ward staff, their resilience and good humour and those of patients, and on my recovery from a decade of mental illness. A future blog will cover my thoughts about and deep gratitude to staff and fellow patients, so this one is about the main lessons I’ve been learnt so far from my (not over-speedy!) recovery. I hope that you find at least some of it useful for you personally and/or professionally.
To cope with a difficult situation, you need the fundamentals of life – money, home, family, friends and whatever else you find essential and sustaining. Unfortunately, while these essentials (or ‘protective factors’) are crucial, they’re not enough to prevent mental illnesses, which have their own dynamics and quirks.
My mental illness, Borderline Personality Disorder, is characterised by a lack of emotional resilience. I went from a super-happy person, at least averagely able to cope with tough stuff, to an emotional wreck for over a decade, sent into a serious tizz by even minor, everyday things going awry. My subjective experience of each of these was of such overwhelming catastrophe that only an extreme response, such as self-harming or being hospitalised, could contain my despair.
So the following reflections on resilience are mainly based on the last few years when I’ve been in recovery from the worst effects of my illness and have been able to develop my resilience muscles. While they are the things that have worked for me, I hope many of them are relevant or adaptable for others.
1. Keeping things in perspective
The most important, over-arching factor in maintaining my equilibrium during minor and even major wobbles is to be able to keep things in perspective. To try keeping things in proportion, I very consciously try to assess how big a deal the situation is. I ask myself questions like:
- Have I understood the situation correctly? This is very important when there are potential misunderstandings between people such as the classic “Why haven’t they replied to my email?” It’s easy to leap to negative assumptions about ourselves but it could be that the person is away/ill/overloaded, an IT glitch etc. Helpful questions include:
- What are other possible explanations for this?
- What would Betty/Billy [someone I trust] think about this?
- How big a problem is this really? To get a handle on the scale of the issue, I find it useful to compare situations to others which were bigger and I coped with them. This is both to keep the problem in perspective and to remind myself that even if it is indeed something terrible, I will be able to cope. For example, when my beloved dog Buddy had a tumour and I had to wait 6 weeks to find out if it was malignant (it wasn’t!!), I desperately wanted to avoid being in meltdown for 6 weeks and knew that it would make no difference to the outcome and was probably unnecessary as I was resolutely hopeful that the tumour would be benign.
- What’s the worst that can happen? How bad would it be if the worst did happen and are there ways I could cope so it wouldn’t be catastrophic or even bad? While much is out of our control or influence, it’s usually possible to make realistic, practical plans for coping as best we can if genuine disaster (such as a major bereavement, not something like missing a train!) does strike. With now three aging dogs, I have to prepare myself for the inevitable. My main reassurance is that my deep happiness at having had the joy and privilege of living with Buddy, Daisy and Pearl will be stronger than my profound grief from their departure to the great dog kennel in the sky. I’m also exploring practical options such as short-term fostering of rescue dogs.
The main thing that enabled me to stay calm before learning that Buddy’s tumour was benign was optimism. Hope. Rabbi Jonathan Sacks wrote in The Dignity of Difference: “One of the most important distinctions I have learned in the course of reflection on Jewish history is the difference between optimism and hope. Optimism is the belief that things will get better. Hope is the belief that, together, we can make things better. Optimism is a passive virtue, hope an active one. It takes no courage to be an optimist, but it takes a great deal of courage to have hope. Knowing what we do of our past, no Jew can be an optimist. But Jews have never – despite a history of sometimes awesome suffering – given up hope”.
Anyway, I managed to convince myself Buddy would be OK, while slowly and tentatively over the weeks beginning to make contingency plans if the worst did occur. During the 6 weeks’ waiting period, Buddy and I went to the Lake District. In Keswick, I was delighted that we found ourselves in beautiful gardens called Hope Park. I have a photo poster on my wall of Buddy lying in front of Hope Park to remind me it’s always important to retain optimism.
A more dynamic aspect of hope is the belief that there can be a solution, resolution or at least amelioration of a difficult situation. So it’s worth trying to improve things rather than fatalistically giving up. When I had several years of chronic stomach pain, it was really important for me to feel I hadn’t exhausted all possible options for ending the pain. I always had yet more ideas up my sleeve in case the current treatment wasn’t working.
3. Avoiding going ‘offline’
The best example I can give of people’s brains freezing is that moment on Dragons’ Den when the entrepreneur is asked for the financial details. Very often, highly skilled, confident, successful people have a visible look of panic, get very flustered and can’t come up with the information. They’re experiencing what my psychiatrist describes as going ‘offline’. The specific part of the brain which is on pause is the prefrontal cortex: the rational, problem-solving bit. The entrepreneurs’ brains haven’t shut down. The part that’s now lively (and no doubt producing thoughts like “Aaaarrgghh! Quickly! You know this. What’s your gross margin? Come on you idiot…..”) is the more emotional, impulsive, not entirely rational part of the brain – the amygdala/limbic system.
Certain situations still instantly trigger me going offline, in particular getting lost or a similar travel problem. My pre-frontal cortex switches off as it’s overtaken by my limbic system.
I feel intense anxiety and panic – an emotion close to terror, completely out of proportion to the situation. And so unhelpful! At the precise moment of needing to be able to think calmly and problem solve, my emotional brain takes over and I’m offline. Complicating matters, this mimics being online, so I am still thinking and it feels like it’s effective thinking. But really it’s pure panic and panic-related, pessimistic thoughts. The irony is that when I’m offline, I can’t think straight so I can’t recognise I’m offline in order to be able to somehow get back online.
I was getting very very frustrated at being offline and wanted to find a way of realising I was offline. I bought a number clicker (or ‘number tally’) – that little metal device that staff use to count how many people are boarding a boat or whatever. At first, I clicked when I realised I had been offline, many many times a day. This didn’t prevent going offline but enabled me to build an awareness of the phenomenon, quantify it and identify what situations provoked panic and brain freeze.
I realised the place I was most often offline was when I was in the kitchen and there were so many tiny, tiny tasks – and each one floored me. This new knowledge meant I could anticipate and avoid going offline in the kitchen or at least more speedily realise I was frozen and do something to shift this, and crack on with the washing up.
Another technique I use to stay online is talking out loud. Sorting the clean laundry is a bit of a palaver as I go offline after each piece of clothing. By saying out loud “t-shirt” “sock” or whatever, I can stay concentrating and having done the identification, I can bung the item in the right pile.
Partly because being offline mimics being online, we can feel we’re actively problem-solving when in fact we’re ruminating. When I’m offline I’ll go over and over something in a futile, moany way or jump to an immediate solution, which during my illness was inevitably self-destructive and a diversion rather than a solution. There’s more imitation with ruminating mimicking problem-solving.
To get round this it’s great when I can plan ahead to avoid problems, panic, going offline and getting very stuck and unhappy. With travel, I now carefully research where I’m going, create documents with the address, postcode and route (even though I use a satnav when driving to a new place – they can go wrong!) If it’s a complicated journey, I laminate the doc so that I can easily find it, amidst the muddle of my bag or the chaos of stuff on the car floor.
Google is both friend and foe for fact-finding. I often look up health issues my dogs are experiencing and usually this is helpful and avoids zooming off into catastrophe and panic mode. But of course Google can often come up with information which is wrong, or not applicable or totally alarming. During a recent Buddy health scare, our brother told me to stop Googling and make an appointment with the vet. I did and all was well.
One of my foster sons has a severe nut and egg allergy, and a severe learning disability so he can’t protect his own consumption. At the possibility, however minimal, that he’d find a peanut down the side of the sofa or whatever, my anxiety levels used to be through the roof. I mentioned this to my therapist and settled myself for 40 minutes of discussion about how this made me feel. Instead he said “Why don’t you get a lock on the larder door?” Brilliant! I did and although it doesn’t entirely eliminate risk, I have somewhere safe to keep anything even vaguely eggy or nutty so I can relax and enjoy our weekends together.
A common source of anxiety for many people is the deadline. I have a ridiculous practice of setting artificial, arbitrary, unnecessary, or made-up deadlines – I did it for this chapter! Once it’s established, I forget that I invented it and feel it’s untouchable. Recognising this is going on means I can check the actual deadline rather than assume or concoct it. This invariably provides me with much more time than my self-created deadline and with instant anxiety reduction.
The need to generate multiple options is covered in the section below on flexibility.
5. Letting things go or parking them
This has probably become my favourite coping technique during my recovery. Completely impossible when I’m offline because when I’m freaking out, whatever’s going on genuinely feels catastrophic and overwhelming. But now I’m living in Mellowville with no demands being made of me, no deadlines and the pure joy of sharing my life with 3 dogs, I put off thinking about or dealing with difficult stuff whenever I (responsibly) can.
When things come along which are anxiety-provoking, I ask myself if I need to address them now. If I don’t, it’s back to playing with the dogs. The best but hardest is to, in the immortal words of young girls’ favourite screen heroine, “Let it go.” Fine for small matters but with anything more substantial it’s unrealistic and somehow feels irresponsible or neglectful.
The great compromise is to park the issue. This is particularly helpful during a really stressful hour/day/year. I use the cliché “I’ll cross that bridge if we come to it” to enable me not to dwell on it, over-anticipate it, or unnecessarily problem-solve it now. Very, very often the bridge/problem/disaster is never reached so that’s a whole load of anxiety spared! A trivial but tasty example of this (pre-illness) was when I ran a commercially wildly unsuccessful chocolate business from a little, not air-conditioned office. I was (not unreasonably!) concerned what would happen to all the chocolate in the summer but decided to wait to see how the ‘business’ developed in the months leading up to then. I parked the dilemma and anxiety, partly through having a contingency plan of buying an air-conditioner. By the time summer came, I was no longer holding chocolate stock in the office. (Not because I’d eaten it all.)
Perhaps it’s having even a sketchy contingency plan which makes parking possible for me. If I know there is a viable option for making things OK in the future, I can shove it to the back of my mind for now. Friends of mine use visualisation techniques to help parking stuff, such as picturing in their mind locking the issue up safely in a little ‘pending’ box or even driving it to a long-term car park! What works better for me is to make a note somewhere I know I can easily find it, often with options for resolving or improving the issue if it does become a live one. (Please see section on Being Organised.)
My mental illness package comes with the unhelpful accessories of rigid thinking and panicky, self-destructive solutions. Now I’m in a much better state, I actively exercise my capacity to think and act flexibly, as nimbleness makes a big difference.
The easiest place to start, I’ve found, is not when there’s a tricky issue but when everything is hunkydory. For example, I gently practice being out of my comfort zone when it doesn’t matter. Books in creativity recommend starting with little things. Not upending your entire organisational structure, but easy stuff like taking a different route to work or reading different magazines or using your cutlery the other way round. Anything to make us do things outside our automated, engrained routines.
An essential part of flexible thinking (and problem-solving and keeping things in perspective) is generating alternative ideas and options. Again creativity books (one of my favourites is Five Star Mind by Tom Wujec), blogs, apps etc are excellent training resources, bursting with a colourful assortment of fun ideas. One I haven’t seen elsewhere but use regularly is still based on the principle of practising when I’m relaxed and whatever’s going on is inconsequential. An exercise which avoids me falling into the trap of seeing people in a rigid way is to practice with TV programmes. I try imagining alternative endings or plot lines for films and dramas. I practice being comfortable with the reality that all of us are full of contradictions – wonderful people still have annoying tendencies and ghastly people have some saving graces. So to find dissonance less wrong-footing, I practice finding one thing I like about a character. And if I can’t genuinely do this, I try to deal with and contain that anxiety or contradiction by not letting this divert me and enjoying the show anyway.
Another technique is photography, a ubiquitous activity nowadays. With the same scenario in front of us (whether it’s a lonesome tree or a crowd of people) as photographers we have many many options. What to include or exclude, what angle to take it from, close-up or longshot etc etc. The very best exercise I find is to move not just the camera and my arms, but my feet. A very different perspective, revealing new details, comes from walking around the tree or the crowd. (Which reminds me of telling my psychiatrist that I was very stuck with a situation because it was like having a giant boulder in my way. He suggested I walk around the boulder! It was a revelation!) Not only is the photography multiple-perspectives good mental and creativity exercise, but I also use this to remind myself there are different perspectives with a situation which feels entirely mono-faceted.
I like to think that the extraordinarily wonderful experience of doing a stand-up comedy course was instrumental in my becoming less stuck in rigid thinking. A large part of humour is unexpected and quirky developments. We were hardcore comedy geeks, finessing and finessing our gags – generating alternatives to get the biggest laugh. It becomes not just walking around the tree but turning it into a pumpkin or a protester camped at the top or …. The more perspectives and the more incongruous the better. TV and radio programmes are again ideal for learning and practice, especially topical news shows which imaginatively and zanily throw a very different light on an issue that’s been pounded into one or two unswerving narratives elsewhere. (I have to say that when I’m in meltdown, seeing the funny side of things is impossible. Which is why it’s so important for me to practice when I’m feeling all relaxed.)
Mainly it involves not being dogmatic. Being all supple and bendy with my thinking, making creative new connections seem to be at the heart of resilience. It’s ta-ra to binary and welcome to exploring alternative perspectives and options.
A few years ago, I felt desperately overloaded, way beyond my capacity to manage. A friend asked me to post a letter as I was going out and passing the postbox. I tried to imagine doing that but it was overwhelming. 100% full means there’s not a drop of spare capacity, even for something teeny. I had to apologise and say I couldn’t manage that. It was a bit like Homer Simpson’s observation: “Every time I learn something new, it pushes some old stuff out.”
One of the main reasons that I’m now so much saner is that I ensure every day and week have enough slack or spare capacity built into them. It’s inevitable that unanticipated things will crop up and I’ve got to have enough emotional energy to manage these. Most people are overloaded – cramped, overwhelming diaries, multiple complex and demanding tasks etc. I won’t wander off into a whole time management thing nor the pressures of 21st century Western living. But I do strongly recommend that wherever possible, you build some spare capacity into your life, as a buffer (or reservoir?) for being able to manage unexpected, additional pressures that occur. Back to the creativity books – they all urge us to have some downtime, not just to recharge but also because it’s often when we’re not focusedly thinking about an issue but are having a walk or a bath that fresh ideas pop up.
Making space, slowing down or stopping can be (or feel) impossible. During a very heavy work period, I would take my laptop to Whipsnade Zoo and sit by the tiger enclosure to do my thinking, planning and writing. Being outdoors is for many in itself a way of feeling less constrained, freer.
I’m now more realistic rather than over-ambitious about what I can do and that’s about accepting my limitations in contrast to a decade of strenuously fighting them and denying their impact.
8. Being organised
I was drowning in depression to such an extent that that it took me several years to realise that the more fundamental problem driving the depression was anxiety. And now I’m no longer depressed, it is anxiety which continues to severely reduce the number of cylinders I’m firing on. I love tools which reduce unnecessary worry. Things like making lists and writing things down mean I don’t have to hold them actively in my head. I’m not dismissing them but doing the opposite. Recognising them and saving them by parking them. The tools I find particularly helpful for being organised (parking, planning, finding) are:
- Remember the Milk – an online task manager, with easily categorisable to-do lists. I’ve got it on my phone, ipad and computer.
- Calendarscope – an online diary which, among other things, enables me to colour code different types of appointments, set reminders, add notes etc.
- Label-maker! I was sceptical when a pal enthused about how his label-maker had revolutionised his efficiency. And it hasn’t exactly had a transformative impact for me but looking for stuff frequently triggers my going offline and if I can see the box or folder or whatever clearly labelled, my brain can click back into helpful functioning.
As well as the gadgets and gizmos, the most useful technique for me in getting difficult things done is to chunk a big task such as a report to write. The two popular sayings for this are: How do you eat an elephant? One bit at a time. How do you climb Everest? One step at a time. I just need to plan the next step. Which at the outset is usually to do the chunking and work out what needs to be done by when. (Using a real not arbitrary deadline!) I get paralysed by even small things like writing an email to a mate and find it helps to make a start by drafting something one day, knowing I’ve got the basis to complete it easily the next.
Yes, I do have all my novels shelved in alphabetical order and an organising system for my books which is geekily close to the Dewey Decimal System. Makes finding the relevant book a swift process.
9. Doing what works for us
I’m convinced that the most powerful personal practices for improving mental health, or ameliorating mental illness, are exercise and mindfulness. Neither work for me! Before, during and since my acute mental illness, the only good feeling I got from exercise was relief when it ended. But I know from the research and loads of people I’ve spoken to that if exercising suits you, it can be incredibly therapeutic and mood-enhancing. As can mindfulness. The one time I can zone out, stay in the moment, quiet my mind etc is when gardening, so I suppose I do seasonally engage in mindfulness. With the added benefit of a fair bit of exercise. I’ve tried yoga, a mindfulness retreat, listening to music, just sitting still etc. Can’t do it. But those who can, and the evidence base, report marvellous effects.
I’ve had a lot of therapy – two rather niche therapies for people with Borderline Personality Disorder (Mentalisation Based Therapy and the unhelpfully named but excellent Dialectical Behavioural Therapy) as well as the deservedly popular Cognitive Behavioural Therapy. And while no fan of the pharmaceutical industry, I appreciatively take medication which takes the edge off my colourful symptoms.
There are masses of books, websites, apps etc with ideas about techniques and practices which can help shore up one’s mental health and resilience, so I won’t go on about these here. (Nor about people self-medicating with drink and/or drugs.) Instead I’ll mention three more strategies which I find work for me.
I have to avoid being over-stimulated, whether by enjoyable or disagreeable and stressful experiences. Both have an identical effect of blowing my mental fuses. The time I realised this was in Cuba, the best place I’ve ever been to. I had three extraordinary weeks there, very full on in terms of history, culture, politics, people, music. By the end of the holiday, I was back in Havana, and to my astonishment I realized I couldn’t leave my hotel. I thought: “I love Cuba, adore Havana, am unlikely ever to return and desperately want to enjoy my last few days in the city. Why can’t I leave the room?” I realised then that over-stimulation blows my fuses, whether through pleasure or pain. Since then I’ve been more careful about pacing myself in fun times as well as difficult ones.
There’s a book called “The Chimp Paradox”, by Steve Peters, who is among other things the psychiatrist of the British cycling team. He calls the pre-frontal cortex the ‘human brain’ (a bit unhelpful because of course it’s all human) and the amygdala/limbic system, the emotional brain, which he refers to as our ‘chimp’. I’ve found invaluable his explanation of the difference between the two. He explains that our chimp is 5 times quicker than our ‘human’ (or problem-solving) brain and also much more powerful. No matter what rational, compelling, helpful thoughts our logical brain is lining up for us, the Chimp overtakes it and bungs in something emotionally based and simplistic.
Once I understood I had this part of my brain that’s very fast, very powerful – the offline part – I could start doing something about it. I could tame the chimp. I could reassure my chimp. I picture having a little chimp living in my heart. And when I can’t understand why I’m feeling a certain way I have a word with my chimp. I’m willing to be kind and patient and understanding with my chimp. When it’s ‘me’, I feel self-indulgent and silly and pathetic taking seriously what ‘I know’ to be a trivial issue I’m over-reacting to. But with a little chimp (perhaps partly because I’m a crazy animal person), I’m patient, respectful, open-minded.
I take the chimp seriously, I empathise, I reassure. Of course, this is exactly what therapists do, and it works. Somehow my chimp cuts to the chase, blows away all the stuff that’s confusing me, and gets to the issue, helping surface stuff which I haven’t be able to get to via normal processing. As Peters puts it, once our chimp is ‘tamed’, it’s possible to return to rational, problem-solving thinking.
And finally – not slouching! Like so much that’s beneficial for me, I’m least able to implement this when I most need it. But as I recover, I find that standing up straight does indeed have an immediate effect on my confidence and mood.
10. Feeling OK about ourselves
After more than a decade of a punishing mental illness and of running Star Wards, I’ve come to the conclusion that the single most important factor is feeling good or at least OK about ourselves. Henry Stewart of the brilliant company Happy is a huge influence on Star Wards and me, as well as being an incredibly supportive and tenacious pal. His mantra is “People work at their best when they feel good about themselves.”
Self-esteem is contextual. I can feel very confident in some roles and situations, and paralyzingly insecure and useless in others. And it’s not necessarily logical, or predictable which situations are paralyzing. But I think I have a primary or over-riding sense of whether I’m OK, very much to do with integrity and accomplishing what I expect. Moderating my expectations so that they’re reasonable is very important. When I first set up Star Wards, I thought it would be brilliant if a few wards took up a few of our ideas. Then as hundreds of wards joined, some with transformative effect, my expectations of what could be achieved became so massive that I became increasingly obsessed and despondent about wards which weren’t managing to achieve great things. A version, I suppose, of the glass half-empty phenomenon and a twist on being optimistic. Over-optimism can be as unhelpful as pessimism!
A breakthrough in kick-starting my recovery, by beginning to trust myself, came when I heard that a then friend said that I “play the loony card” to get out of things. Previously that would have resulted in being engulfed in very hostile feelings about myself and in instant meltdown. But this accusation was manifestly the opposite of the situation, having soldiered on working, looking after my foster sons, and generally managing to live independently (albeit very messily) ‘in the community’. I astonished myself by recognising that the (now ex) friend was not only wrong but also someone who made me feel worse about myself.
I now try whenever possible only to be in situations where, and with people with whom, I can feel OK about myself. And to have manageable expectations about what I can do each day and month. I’ve embraced the whole good-enough parenting ethos. Good-enough self-parenting. Good enough working. Good-enough being.
Severe and prolonged mental illness is of course quite a challenge to being resilient! And for most of the ideas and techniques I’ve included here, I had to be guided through them each time by my therapists as I simply couldn’t manage them alone when in crisis. During that agonising decade, being resilient was, for me, about tolerating being alive and getting through the next hour and day.
But all that therapist-led learning and coaching has resulted in a degree of resilience which amazes me and is helping me to glide calmly and effectively through demanding situations. Yet this piece has whizzed past what truly helps me most – and that is love. The love of my wondrous siblings, the rest of the family, friends, colleagues and strangers and of course the unconditional, simple, magnificent affection of my dogs has transformed many a potential nightmare into at worst an ugly but manageable and, at best, a truly uplifting experience.