Ruth’s Disjointed Alphabet Series: U is for University

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‘Blowing Bubbles’ by digital artist Cyril Rolando. 2009

My current mood has shifted in the last few months from overwhelming sadness, to long periods of numbness followed by a sporadic burst of emotion. Initially, I saw this as an improvement – however I quickly realised that this wasn’t the case. You see, feeling overwhelmingly sad is never pleasant. But in most cases it means you lack the energy and desire for other things, whether that’s eating or an activity requiring some level of motivation. Therefore my only possible response is to sleep as much as I can while the days move past me. In my current numbness however, I am by most estimates fairly functional. I’m still depressed and I still struggle with anxiety, but I’m able to move some of my more intrusive thoughts aside and continue with my day which leads me to wonder if I’m really sad at all. The answer of course is yes, you fool, because the numbness only seems to serve as a countdown to an inevitable outburst of distress – in some cases resulting in self-harming behaviour when I can’t cope with the sudden onset. As an example: the other day after another numb period I was out and about, and upon realising I couldn’t find an address I was looking for I immediately broke down in tears in the middle of the road, cursing myself for being such a useless human being.

It is this very same mood I was in many mornings ago during a meeting with one of my support workers. Somewhere amongst the more general questions of how I was feeling, I had an emotional outburst and broke down talking about how I felt like I wasn’t making any progress with my depression (a frequent fear of mine). In this I also revealed how I was not being entirely truthful about my thoughts and behaviours when asked if I had been having suicidal inclinations. The reason for the lies were fairly simple in my mind: I didn’t want to feel like I was failing others by not improving as quickly as I thought I should be, and I was holding on to the fear that they’ll give up on me if I told them the truth. This of course just results in keeping thoughts to yourself that you would probably feel better with sharing instead. But it’s a scary step in itself to recognise that you yourself are disappointed when you wake up every morning, not to mention sharing that thought with someone else. Something I noticed though was that this ‘hiding’ is something I’ve done countless times in the past, and here I was doing it again with my mental health. When you can see that someone cares about your wellbeing, you no longer want to share with them the whole picture of how you view yourself or the trauma you’ve been through, because you don’t want to either a) hurt them, or b) have them become frustrated with you or even put off, which in many cases hurts more. But in admitting all of this out loud I did start to see some of the faulty mechanisms involved that would ultimately prevent me from feeling better.

So instead, we spoke about my real mood and the coping mechanisms I’ve perhaps erroneously developed for myself. And in discussing the things I’d been through both as a child and more recently, as well as the importance of being easy on myself, she mentioned something that stuck out to me – leaving university is both a very big life event and a very big change for many people. This was comforting to hear, as in the months since I’ve graduated from university I’ve been feeling very negative about myself, which has undoubtedly contributed to the state I’m in now. I had finished my second year with a first (the highest possible grade in UK universities) in nearly all of my modules while simultaneously balancing a part-time job and a place on the executive team of a student social enterprise. I even worked full time for the entire duration of the following summer. But for some reason, as soon as my third year began I couldn’t cope any more. Everything was different – I felt different – and I was burned out. I saw this as me just falling back into my depression from previous years, but even when I dropped my other activities and commitments in the hopes it would help me cope better, something in the back of my mind had me on edge. And as I reflect on it more I feel I’m beginning to understand part of what that was – I was anxious about soon was losing part of who I was. For a very long time, I’ve always defined myself as Ruth the Student. Seventeen years of my life have been spent in school or higher education institutions. It was all I knew, it was all I felt good at. Even when I worked during summer holidays or completed internships I always knew that I was a student, and that I would be going back. Additionally although I didn’t realise it at the time, university had become a safe place I could go to when other things around me such as my home life became too chaotic or disorientating. It was a place to run away and feel safe again, and upon graduating and returning to London I realised I no longer had a safe place to go. But still I tried to adjust to my post-university world because I didn’t want everyone to think I had given up, even though I knew mentally I was slowly deteriorating. I sometimes struggle to get my words out, and I definitely didn’t have the words to describe it all as I do now. But I do think I tried my best to explain to others what I thought was happening. Nonetheless, it’s heartbreaking when the people most important to you who you thought loved and cared about you, don’t seem to even want to understand and instead think you’ve just stopped trying for yourself.

Many people find it difficult to cope with university. I’ve met many people, especially more recently, whose attempts at university have driven them to either contemplate or attempt suicide on several occasions. There can be a lot of pressure depending on many things, such as where you attend and the course you study, as well as how much individual pressure you place on yourself. I for one know I certainly came close a few times to not making it to my graduation alive. But I feel that in addition to how stressful university can be, something that people often overlook is how stressful the transition out of that system can be for some people. And it saddens me that if I had just been struggling with the former, some people may have been more understanding. There are, of course, other educational steps a person can take after their initial degree if they choose to do so. But these paths aren’t hard-wired into us from a young age like GCSEs, A-Levels and undergraduate degrees are. Besides that, no one can be a student forever. And even if you’re working towards a Master’s or a PhD, if you are someone who has defined themselves as someone who is good at being a student, sooner or later you’ll have to come to terms with this new world you don’t recognise yourself in any more.

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Ruth’s Disjointed Alphabet Series: A is for Anxiety

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‘Anxiety’ by Caroro/Morgan Allen

It’s been awhile since I’ve written anything to complement the alphabet series, so I thought I would get things back into gear by starting with something else I tend to struggle with alongside depression – anxiety.

I’ve tried thinking about the first time I truly experienced anxiety (and I mean really, really feeling it) and I came up blank. I believe it’s because the line between what’s considered normal, and what definitely isn’t, is quite blurred. I’m sure most people have had feelings of anxiety to at least some degree, as it’s common to feel nervous or fearful at the thought of a stressful decision or event. In my case however, the awareness of my anxiety came when I realised that the nervous feeling I had before an exam for example, was very far removed from the sickening, crippling feeling that I was waking up with every morning for no apparent reason. In this sense, anxiety tends to become a clinical problem when those normally understandable fears and worries become so strong and last for such a long time, that it becomes overwhelming. Mind, the mental health charity, defines anxiety in the following way:

“Anxiety is a word we use to describe feelings of unease, worry and fear. It incorporates both the emotions and the physical sensations we might experience when we are worried or nervous about something. Although we usually find it unpleasant, anxiety is related to the ‘fight or flight’ response – our normal biological reaction to feeling threatened.”

Now, upon coming across this a few weeks ago, it was actually the first time I had read any sort of definition of what anxiety is. To me it was just a feeling, but while reading the definition above there were many parts of it that I could relate to. For whatever reason, my anxiety tends to be worse first thing in the morning. In fact in most cases it’s the reason my body wakes up at all, as I slowly start to notice the sense of unease and fear. For lack of a better term, it often feels as though there’s a black hole right in the middle of my chest, slowly bubbling and growing as it takes in all my other senses and feelings until it’s the only thing left for me to feel. It usually slowly dissipates as the day goes on, however it will quickly return if I happen to remember something negative or sad, or if I’m in a particular place that holds a lot of memories for me. With regards to Mind’s definition, my experience of anxiety is definitely a lot more on the physiological side. I will often feel physically sick, and sometimes I actually am. I also tend to lose my appetite completely and I can get quite shaky too. On rarer occasions, if I’m particularly overwhelmed I experience full on panic attacks. In light of all this, I completed an exercise that allowed me to create my own personal definition of anxiety, which I’ve included below:

“Anxiety is a word that describes a general feeling of fear and dread, almost simultaneously. It can occur at any time, although I often experience it first thing in the morning, or in relation to a negative thought, memory or dream. It incorporates the emotional aspects, but is mostly very physical – it feels as though there is a constant black hole in the middle of my chest. I will often feel nauseous and uneasy, and will find it difficult to concentrate on other things.”

Even though this is what anxiety feels like to me, it was interesting to read about some of the other ways that people experience the same thing. These included feelings of paranoia, doubt, catastrophic thinking, isolation and even compulsions and rituals – similar to Obsessive-Compulsive Disorder (OCD).

However, perhaps it’s the psychology student in me but I couldn’t help feeling a little agitated at the last sentence of Mind’s definition. For anyone who hasn’t heard the term before, the so-called ‘fight-or-flight’ response is one frequently mentioned in psychology, particularly the area of evolutionary psychology that attempts to explain useful psychological traits, such as memory, as adaptations – that is, as the functional products of natural selection. If I remember correctly, the response is actually related to our autonomic nervous system (ANS). When presented with acute fear or stress, the two branches of the ANS take action: the sympathetic nervous system is activated due to a sudden release of hormones, which in turn stimulates the adrenal glands – triggering the release of neurotransmitters such as adrenaline and noradrenaline. This is what causes our accelerated heart and breathing rates, as well as reactions such as tunnel vision and auditory exclusion. Meanwhile, the parasympathetic nervous system activates the “rest and digest” response and returns the body to its pre-arousal levels after the threat has ceased.

But somewhere along the line, this physiological response became a simple catch-all explanation for any general feeling of unease. When referring to anxiety as a disorder, I personally don’t believe it’s correct to say it simply stems from this response mechanism. There are countless theories and suggestions throughout the psychological world as to what ‘causes’ our mental health problems, and all of them come with their supporting evidence and criticisms. For example, within the branch of humanistic psychology popularised by the American psychologist Carl Rogers, anxiety is seen as the resulting effect when there is a disparity between our ‘self-image’ (how we currently see ourselves) and our ‘ideal self’ (an embodiment of the person we wish to be, which includes our goals and ambitions). Contrarily Sigmund Freud, the father of psychoanalysis, suggested that anxiety is the result of conflicts between the conscious and the unconscious, or of some repressed memory/traumatic experience that we are refusing to bring into the present (which he suggested for pretty much everything, really). Whatever the likely explanation, one thing that is instrumentally clear is that anxiety can have a range of causes, if there’s any cause at all, and that people can experience anxiety in a wide variety of ways.

Quite predictably, anxiety can also have an effect on your relations with other people. I would say that after people get to know me, I am quite a bubbly and warm person. The problem it seems is actually getting to that point, as I’m usually too overcome with worry to open up properly. For example upon meeting new people, I can sometimes shut myself away inside, opting to listen, smile and nod rather than actually saying something myself. On the outside, I’ve figured I must seem abnormally quiet, or even just plain disinterested. On the inside however, my mind is actually doing something along the lines of this:

Right, new humans. We really want them to like you remember so let’s not screw this up. That’s it, no more shy girl, let’s bring The Cool Ruth out to play. Note to self: Don’t ever refer to yourself as The Cool Ruth out loud. Also, maybe don’t call them humans. How about you tell that funny joke you know? No not that one, the one that’s actually funny that you read on the internet that time. Yes, I know that there are many times that you are on the internet but can you just work with me here, we’re trying to build a conversation. Wait, wait they’re looking at you, what did you miss? Damn it OK be cool be cool, just smile and nod and maybe throw a little laugh in there. You see, this is why we can’t have nice things. Good, they’ve started talking again, try to pay attention this time so you can nip in with something witty. No, I said witty not silly. Well if you say that then they’re just going to think you’re weird. Oh great, you blurted it out anyway and now they’re looking at you funny. Just… just go back to smiling and nodding until this is over.

This is pretty much the cycle I go through every time I meet new people, especially if for whatever reason I’m trying to impress them or want them to like me. Although frustrating all on its own, it can be even more upsetting to know that others might think you’re disinterested or not paying attention, when really the truth is nothing like that at all.

Anxiety can be a very unpleasant condition to manage, as some ‘triggers’ are completely out of your control – if there’s even a trigger at all. Although I would say my morning anxiety has improved over the last couple of months, I still struggle with it on the off day and I always find myself desperately wondering why, even though in many cases I know there’s no real reason. I even feel it now as I’m writing this all down, on a rainy afternoon as I sit in a peaceful library in Euston. But I am hopeful that there are ways to effectively manage it that don’t utilise my current coping mechanism of trying to sleep it away.

I’ve recently started attending a course as part of a programme designed to contribute towards wellbeing. Throughout the coming weeks, I’ll be learning some of the (perhaps more healthy) coping mechanisms that can be used to help me manage my anxiety better. It’s not promised that all of the techniques will be of use to everyone, which I suspected anyway as people are different after all. But I will nonetheless try to share any new knowledge I come across. I’ll even throw in a few more of my annotated illustrations to help move things along. Stay tuned.

Ruth’s Disjointed Alphabet Series: O is for Overwhelmed

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‘Overwhelmed’ by Carolyn LeGrand

01:12am

There is too much in my head and I can’t think straight it’s weighing me down it’s too much too much in my head I can’t concentrate on just one without something else taking its place it’s too much too many thoughts too many worries too many fears too many negatives too many tears too many intrusive thoughts I wish there was a way to make them stop make it all stop I can’t see anymore it’s too much at one time I jus-

Ruth’s Disjointed Alphabet Series: M is for Mirtazapine

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Illustration by Olaf Hajek

Due to a series of unpleasant, negative and fairly painful thoughts that don’t seem to want to leave me alone, I have done what any other normal individual would do who can’t properly concentrate during their attempted watch of 21 Jump Street – I have created a wordpress blog.

I’ve decided to kick things off with the first of what I hope will be an alphabet series centered on mental health matters. Only we’re going to start with M first because leave me alone.

As it stands now it is currently 12.04am and I am sitting in bed waiting for the supposed drowsiness effects of Mirtazapine to kick in. For those who aren’t aware, Mirtazapine is an antidepressant. For those who may not have connected the dots, that means I have depression. A fairly new antidepressant, I thought it might be interesting to compare it to another antidepressant I have experience of: Sertraline. I first took Sertraline during my third year at university, in part due to the added symptom of depersonalisation to my usual depression. Depersonalisation is something I intend to talk about separately in the future – given that we have a considerable history together – but to summarise it is the overwhelming feeling of you and/or the world not being real. Despite being a disturbing experience, it is a fairly common occurrence that can be seen with anything from borderline personality disorder to the use of psychedelic drugs. In my case I tend to experience it during periods of extreme anxiety or depression, and it usually serves as a self-indicator that I’m likely losing my mind and should do something. Therefore given what seems to be the NHS’ eagerness to administer pharmaceutical drugs for any and everything, after speaking with my university GP I was given a choice between Sertraline and another antidepressant, Citalopram. It didn’t occur to me at the time but I probably should have questioned why the medically-trained professional was asking me to randomly pick an antidepressant rather than deciding which was best for me based on, you know, knowledge or something – but I digress. In the end I think I chose Sertraline because I liked the name more; it sounded like it could be an energy drink or something equally exciting. After coughing up my own money for drugs I didn’t particularly want to take in the first place, I began treatment. I had done enough research on antidepressants both personally and as part of my psychology course to know that side effects are quite common. But interestingly enough Mirtazapine and Sertraline seemed to be quite different.

Sertraline vs Mirtazapine: Death Match 

Personally Mirtazapine immediately has the advantage for me, because as someone who has felt body tremors with Sertraline (along with suicidal thoughts, insomnia and nausea)  they are, in no uncertain terms, a can of nope that I refuse to deal with again. Of course everyone is different, and I’m sure Sertraline has been great for at least someone out there. Additionally from what I’ve gathered from various internet forums, the most prevalent negatives cited for Mirtazapine seem to be either the inability to sleep for anything less than 12 hours, or the gaining of 20 stone in a week. I have yet to experience any of this, so I am either fortunate in that respect or someone with mutated genes. Regardless these aren’t things that would bother me too much anyway, especially the weight gain considering I have lost quite a bit in my current crisis.

Therefore as it stands I am quite happy with the bond me and Mirtazapine seem to be building together. However that being said I may just be experiencing some delayed effects. If so I will likely provide an update in a few weeks time to share my new side effect of inverted nipples or something else only I would be unlucky enough to develop.