Welcome to Mental Health Awareness Week

Stress, Depression and Anxiety – Aren’t They All The Same Thing?

I’ve chosen to blog about these three conditions because they are exactly that. Three conditions, not one condition with three names which can be used interchangeably. Whilst awareness about the existence and very real impact of these conditions is increasing, there’s still a tendency to lump them all into one big melting pot and assume that in terms of support, a one-size-fits-all approach will be sufficient.

I’ve suffered bouts of all three of these during my adult life, and looking back now I can see patterns of all of them peppered throughout various experiences in my teens and even childhood. At times I have been misdiagnosed and treated for the wrong thing, which has only served to compound the difficulties.

This blog entry is not intended to provide medical advice or offer a set of tools for diagnosis. I can only blog about my personal experience with these three conditions and use that to highlight the major differences between them. I hope that this will provide a small amount of insight into how they need to be tackled and approached in different ways.

Stress

Stress was the first condition I was diagnosed with, in my early twenties. I was training as a teacher at a school in the north west of England and for the first time in my life, I was struggling with the requirements of a qualification. This was a completely unknown circumstance for me, as a natural academic. GCSEs, A-Levels, my degree and my masters, none of these had posed any problem for me. But when it came to the demands and rigors of this course, I was beginning to fail.

The roots of my own experience with stress were lodged in a physical illness. During the Easter holidays, when I should have been getting some rest, I was laid low with a nasty ear infection. I couldn’t sleep, I couldn’t move without considerable pain and I was in an awful mess emotionally because I was so tired and sore all the time. By the time I was due to start my final placement I wasn’t fit to go, and ended up missing the first week of school.

This didn’t get me off to a good start with my mentor, head of department or colleagues and was the beginning of a long and uphill struggle to get through the term.

For a long time, I assumed that I just couldn’t throw off the illness. Some of the effects were similar to what I’d endured with the ear infection, but over that term things got far worse. My symptoms included:

  • Being unable to sleep due to obsessive thinking patterns.
  • Extreme lethargy
  • Memory problems, couldn’t retain short term information
  • Lack of interest and motivation in what I was doing
  • Lack of appetite and shrunken stomach
  • Repeated vomiting after eating, sometimes five or six times within a day
  • Rapid weight loss
  • Brittle hair, acne and weak nails
  • Being short tempered
  • Constantly feeling near to tears
  • Inflammation of my Asthma, struggling to breathe

The thing that saved me in terms of my stress condition was being told that I had failed the course. It was an escape and removed many of the problems that had been weighing on me quite so heavily. With the money left over from my bursary, I was able to have some time off to rest that summer before returning to a fresh placement with a clean slate the following January.

Looking back now, I shouldn’t have ignored or brushed off those problems for as long as I did, and neither should the people around me. I should have gone to a doctor and asked for help and support. The placement was three months long, far too long to ignore what I thought were the after affects of an infection.

The most difficult thing to get a handle on was that I was out of control, because my experience of stress was a feeling that I was trying to keep control. I couldn’t see that I was failing and that my difficulties and failing health should have been key indicators that things were wrong. I was so busy convincing myself that I was OK that I didn’t stop to realise that I wasn’t. There’s a difference between reassuring yourself that you’re OK once or twice when you are nervous, but when you are repeating it like a mantra every few minutes in the face of overwhelming evidence that you’re struggling to cope, it’s often a clear sign that you are far from OK. Getting help at this point is not a sign of weakness, it’s a coping tactic. I wish I had known that when I was starting out as a teacher.

Depression

The following summer, things had gotten worse. I went through a very difficult time where my relationships with my boyfriend and friends took a battering. I had nine interviews for teaching positions and still didn’t have a teaching job.

Teaching interviews are grueling compared to the average office based interview, which was all I had experienced previously. Rather than sitting down to a one hour chat and maybe completing an IT test of some kind, my teaching interviews lasted all day. They involved tours of the school, question and answer sessions, a teaching session and full debrief afterwards, interviews with pupils, a formal lunch with the department and a final formal interview with the head teacher, a member of the department and representatives from the board of governors. Each one had to be applied to separately and then prepared for separately. By the end of that experience you’ve been questioned and judged on your teaching ethos, your personality, your subject, your work history, your academic ability and your future hopes.

To go through that nine times and not have a job at the end of it was crucifying. My self esteem had been shattered and there was no part of my life that I felt positive or good about. Relationships with my family were also strained and I had no income or way of paying my rent or buying food.

Sinking into depression was a very gradual thing. I stopped eating first. This was part of an effort to save money initially, cutting down my meals and portion sizes, then skipping meals. Then I started to feel guilty if I ate food because I had no money, and I started to feel as if I wasn’t worth the food. Soon I wasn’t eating at all.

Then I started to have trouble leaving the house. Again I felt worthless, like I didn’t want anyone to see me or look at me, because I believed there would be a negative judgement. Afterall, everyone else in my life had already made these decisions about me, why would strangers be any different? Gradually, one day at a time, my sphere of movement became smaller and smaller. I wasn’t eating, so I didn’t go to the bathroom as much. I wasn’t going out, so why did it matter whether I showered or not? Or whether my clothes were clean? Why did getting out of bed matter? Eventually, I shrank away into a smaller and smaller space, feeling like I was less and less of a person.

By the time I was persuaded to get help, I had lost a third of my body weight. My hair was matter, my skin was in terrible condition, I stank and I was constantly crying. When I started trying to eat again, I would vomit immediately. For days I’d been having dreams and daydreams about committing suicide. One in particular was so vivid and sensory that I don’t know whether I actually attempted it or not and I’m a little scared even now to go back and find out.

I had always been a person who loved life and believed in a bright future. I was an optimist, a believer and a hard worker. It terrifies me that I had reached the point where I didn’t think I was worth existing. Where I didn’t think there was a way out or a light at the end of the tunnel. I just wanted to close the hole over my head and stay in the darkness. More than anything, I was scared that doing anything or taking any action would make things worse.

It took a couple of different types of tablets to even out my mood swings, to enable me to think clearly. Along with bout of therapy to try and unpick some of the damage, and the constant support and love of my boyfriend, who I had hurt very deeply while trapped in my own personal hell. He’s now my husband. I have known since emerging from that awful time that he was the right man to spend my life with. The difference between the stress and depression was the when I was stressed, I honestly thought things were going to be fine and that I was coping. When I was depressed, I believed I had failed at everything and would be better off dead.

Anxiety

About a year ago, I was finally diagnosed with anxiety. My therapist, who I’ve been seeing for the last six months, has suggested that it might be caused by PTSD, but this hasn’t been confirmed by a doctor.

Everyone has moments when they panic. When something shocks them, or they remember something at the last minute and your blood starts pumping and you get that head rush with the metallic taste of adrenaline on the back of your tongue. We all have that. It might be a near miss traffic accident, or seeing a child about to do something dangerous, or even finding a great big hairy spider sat on your pillow before bedtime.

The best way I have to describe my experiences with anxiety is that I felt like that all of the time, as a bare minimum. I didn’t know what it was like to not be worried.

The symptoms were quite similar to stress, but the emotional triggers behind them were very different indeed. Again, I was struggling to sleep. But this time, I wasn’t running through coping mechanisms, I was running through fears. Fears about my job, about my finances, about my friends and my social activities – all of these things would emerge from my brain like thick black ooze, coating all of my thoughts and stopping me from being able to rest. The constant refrain of ‘What if, what if, what if…?’

My adrenaline was through the roof. I would jump at unexpected noises or voices behind me. Flinch from an unexpected touch. My husband describes this as being ‘fight or flight’, the sensation of either wanting to pick a fight with the perceived threat or wanting to run away as fast as you can. You’re tensed and ready for action all the time. Let me tell you something, that is exhausting. My muscled ached, my joints ached, I had chronic headaches and my ears rang so often I thought I had tinnitus.

I felt frightened, all of the time. Combined with an anger and frustration on a conscious level because I didn’t always know what I was frightened of. Social situations, particularly where there was the danger of running into people who disliked me, were almost unbearable because I could barely hold a conversation and spent the whole night spinning around like a top, trying to keep everyone in view. The sound of an unwelcome voice behind me or the unexpected sight of someone that I didn’t want any contact with was enough to make me feel out of control.

People use the phrase panic attack too often for my taste. Being a little scared is not a panic attack. The last time I had a panic attack in public, I lost complete control of myself. After attending a drama-based social event in a room with no windows and only one exit, I began to feel trapped and like there was no air in the room. I started hyperventilating, my muscles tensed up and soon, without having made a conscious decision to, I was sat next to the door, back against the wall, fingers clenched and ready to run away. A few minutes later I was sobbing uncontrollably in a toilet cubicle, door locked, back braced against it to feel even remotely safe. Eventually my fiancé took me home. I could not have told anyone what triggered the attack but I was overwhelmed by the feeling that I wasn’t safe and couldn’t get to a place where I would be safe.

When you live in a state of heightened physical and emotional alert, you begin to have disproportionate responses to minor events. Things like arriving at a workplace to find that your usual parking space is gone, or being asked to move a meeting to the room next door or not having a piece of post turn up when you were expecting it. On a good day I laugh at all of those, if they deserve a reaction at all. A quick tut, shrugged shoulders, a roll of the eyes at best. When I’m in a state of heightened alert though, these events are often more than I can deal with. But I needed that space, I needed that room and I needed that post – why? Because they were part of my plan to be in a safe space where I knew what to expect and how I could cope, and I don’t have any energy spare for a contingency plan, even a minor one.

Anxiety can manifest in the tiniest of ways. I hate walking through a door first into a crowded room when I am with someone. I hate the idea that people are looking at me and comparing me to the person I am with. I had to explain to my very chivalrous husband that holding open the door and saying ‘Ladies first’ was a lovely gesture but it struck terror into my heart every time. He now walks in first and reaches back for my hand, reassuring me that I’m not alone. I also hate making phonecalls. Answering the phone is fine because I know the person wants to talk to me, but actually making calls is a nightmare. I would much rather email, or text. Thankfully my boss understands this and so when I text her, she calls me back. If someone you know has funny little habits like this, don’t ridicule them or call attention to them. For all you know, they are the lynch pins to their method of coping with the demands of life.

I currently take tablets to control this condition because they regulate my brain chemistry to prevent the build up of chemicals that are currently working in overdrive to keep me in that state. I recently had to raise my dose because I found that while I might be able to function, I was beginning to get worried about everything again and was expending a lot of my energy talking myself down from rising panic over very normal situations. Eventually I will be able to find coping mechanisms to handle those things and bring my own body chemistry under control, but I’m prepared for that to take years. So is my doctor. So are my employers. So is my husband. Not one of those people has said ‘so are you better yet?’ in response to me having a good day and for that, I am very lucky woman.

Suggestions for ways you can help

Here are some suggestions that I did find, or would have found, helpful in the grip of each of these conditions, but before you charge headlong into the list thinking that I have the answers, I implore you to pay attention to this first and prime piece of advice – if you know someone who you think is struggling with one of these conditions, talk to them and find out how they are feeling before you take any action at all. Doing the wrong thing can sometimes be as damaging as doing nothing and it is essential that people who are dealing with these things should be in control of their own coping and recovery strategies. Don’t do it for them, do it with them, and listen to what they have to say.

If you know someone who is dealing with Stress:

  • Don’t keep telling them they can cope or that they are strong. It will make them feel that they SHOULD be coping or reinforce their belief that they are coping.
  • Ask if there is anything you can do to help. Or better still – offer. My housemate and boyfriend took over cooking dinner when I was going through stress, which made sure that I ate at least once a day. Without that support I would have been much worse.
  • Be aware that the question ‘Is everything alright?’ can be overwhelming, because it subconsciously requires them to think about everything at once and they will just shut down with an answer of ‘Everything’s Fine’ or ‘I’m OK’, because that’s too scary to contemplate. Don’t blithely take their word for it when they say they are OK, especially if you have noticed changes in their physical wellbeing.  Instead, ask about specific things (such as “how are you doing with that project for Jack’s department?” or “Have you got that history essay finished yet?”) and this will allow them to focus on that one thing. You might get a more honest answer and an opportunity to help might present itself.

If you know someone who is dealing with Depression:

  • Reassure them that they are worthy of love without qualifiers. A well meaning friend tried to tell me that I would get a good job soon, which inadvertently made me even more suicidal, because I was worried about letting them down by failing.
  • Just do the little things, rather than asking. A cup of tea, a bit of cake, an email or text message to say you’re thinking of them. Asking ‘is there anything I can do’ is well meaning, but it requires a broken person to come up with an answer, and more often than not my response in that situation would be ‘No thankyou’, even though I was starving myself to death with no personal hygiene routine. This was not because I didn’t want help, but because I didn’t feel like anything would help.
  • Do suggest that they go to a doctor and reassure them that they are unwell, not failing at being a member of the human race. Tell them that you know this isn’t who they are and that you know they are struggling. When I had depression I felt as though everyone was blind to what I was going through. Having someone say ‘I know things are difficult for you right now’ was a wonderful thing to hear, because it meant that I wasn’t invisible.

If you know someone who is dealing with Anxiety

  • If you are present when someone is having an anxiety attack, don’t belittle their fears. Telling someone who is frightened that there is nothing to be afraid of makes you part of the threat. Instead tell them that they are safe and you are with them. The issues may look like molehills to you, but they are climbing mountains.
  • Don’t try to pressure them into attending social events, especially large scale ones. Offer alternatives, a one to one coffee, a meet up with a couple of friends or a trip to the movies will be far less intimidating than a party where anyone could show up.
  • Don’t reach out and touch them unexpectedly if they seem upset. It could make the panic worse or even cause them to lash out if they are having an attack. Offer them a physical support, (“Here, take my hand, you’re going to be alright”) but don’t invade their personal space.
  • If someone seems to be overreacting to small things, especially if this is out of character, don’t tell them they are being stupid. Sometimes they know that the way they are reacting is foolish and they may already be frustrated and angry with themselves. It’s much better to acknowledge that someone is upset that imply that they should not be (“You seem pretty upset about this, do you want to talk about it?”)

These conditions are very separate and there are different ways you can offer help and support for each one. As I said, these experiences are all mine and the advice offered is based on those experiences. All three conditions are complex and the effects will vary from person to person. If you believe that you are suffering from any of these conditions, it is essential that you get help and support from a medical professional. If you know someone who is struggling in these ways, encourage them to ask for help. I now use the following mantra when working through these issues.

“If in doubt, see a doctor. If it is nothing, they will tell you it’s nothing. If it is something, they will help you.”

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