Mental Health Awareness Week Part Two: Relationships

I know Mental Health Awareness Week was a couple of weeks ago now but I don’t think it’s ever a bad time to raise awareness about and acceptance of mental health and mental health issues, and since the official theme this year was relationships I thought I should probably write a post about it!

I chose that particular quote from Carrie Mathison (Homeland character) because I really identify with her as a character in a lot of ways and because a big part of her character development over the five series so far has been her growing realisation that people can’t exist totally independently without any relationships with other people but also that you need to be able to rely on yourself and that relationships aren’t always reliable and you need to be able to adapt and manage that.  Carrie as a character has bipolar disorder and a lot of her difficulties with relationships and boundaries are linked to that (which I’ve written about in another blog post called Learning emotion regulation via Carrie Mathison and in my other, Homeland-focussed blog Carrie Mathison’s Diary).  The two quotes that really get me are when Carrie says in season one “I’m gonna be alone my whole life, aren’t I?” and then this quote, “Maybe I don’t want to be alone my whole fucking life!” which is part of her starting to realise that she really does need relationships with other people.

Relationships are vital for everyone and especially for people experiencing mental health issues who can often become socially isolated or feel alienated from people around them. There are so many different reasons for this from factors relating to others such as fear of judgment, bullying, lack of motivation or energy to be around people or stigma to internal factors like paranoid thoughts, delusions or anxiety and it’s important to recognise that everyone experiences different thoughts and feelings. Statistics from the Mental Health Foundation say that nine out of ten people with mental health issues have experienced stigma about their mental health which is horrible and can be really detrimental to people’s social relationships. Relationships are fundamental to being a human- we really are social animals. I feel a bit ironic writing this- I remember a psychologist I used to over a decade ago repeatedly telling me that and I didn’t believe her; it took until several years of volunteering in teenage self esteem groups through Mind and meeting people as an adult who have genuinely changed my life to realise just how important social relationships are. But we need them to survive and they are essential for mental health.

One way we can tell how important relationships are is by thinking about language and communication- across the world, different cultures have evolved their own ways to communicate but it’s the communication itself that is vital, and not just in humans. Relationships were important in prehistoric times because they allowed people to gather and share food, protect each other, build shelters, find sustenance, reproduce, take care of each other and basically maximise chances of survival and that need is hardwired into the way our brains work (for anyone interested in neuroscience, have a look at how the amygdala and the neocortex are involved in relationships and attachment- it’s really interesting but don’t want to turn this post into a science essay!). I’m not going to go into the psychological, sociological, linguistic or neuroscientific aspects of attachment because that could be several PhDs in itself but wanted to highlight the way in which relationships are essential for human survival.

The main types of relationship I’m going to look at in this post are family relationships, friendships and ‘functional’ relationships. The last one sounds a bit negative but I really don’t mean it to- I just mean relationships with very specific constraints or boundaries but serve a function. Relationships can be positive or negative and you don’t necessarily have to like someone to have a relationship with them and it’s defined by repeated social contact with someone rather than how much you like them. I used to see a psychologist who I didn’t particularly ‘like’ but I saw her every week and although I hated the therapy sessions they were actually useful in a very indirect way so that was a positive functional relationship even though I didn’t like seeing her. I think a lot of young people have similar relationships with teachers! You can also have close or distant relationships depending on how close (emotionally) you feel to someone and that doesn’t depend on physical distance- for years, my best friend lived on the other side of the world but she was still my closest friend because of how much I trusted her and how close we were emotionally whereas I lived in the same house as my brother but I didn’t feel anywhere near as comfortable emotionally around him.

It’s important to have a mix of relationships around you, close and distant, in order to have stable mental health and to feel like you are connected to people around you. Too many close relationships can make you vulnerable or prone to becoming overwhelmed whereas too many distant relationships without closeness can lead to social isolation. It’s a balance and it’s hard to manage, especially for people with mental health issues who can often experience difficulties with boundaries. I’m definitely prone to this- I’ve lost a lot of friendships in the past from being ‘too intense’ or contacting people too much and I find it hard to regulate because when I feel comfortable around someone, I REALLY like them and want to contact them all the time but I’m a lot more aware of it now and am learning to manage it. Last year, my best friend of twenty years asked me not to contact her any more and that was so hard to deal with (and still is) but I’ve learned a lot from that experience. Close relationships are important but it’s even more important not to be reliant on them because you can’t control other people and you seriously never know what might happen in the future.

Family relationships are always a minefield and I don’t want to talk about them too much because I know it can be a sensitive topic for some people but they’re there from the minute a person is born, and are massively influential on a person’s development both in childhood and how it affects you as an adult. I’m lucky to have a fairly massive family- I have thirty cousins, lots of ‘extended cousins’, aunts and uncles, my nan and her ‘man friends’ (one of whom was like my granddad growing up which is why I’ve mentioned them), parents and a brother who (mostly) get on relatively well. Apart from my parents, they mostly live in Glasgow so I don’t see them that often but my family is very, very close and I love spending time with my cousins although I only see them a couple of times a year. One thing I really wish is that I’d grown up in Scotland so I could feel more like a part of a big, close family- my cousins are awesome and I love staying with them but it’s not the same as if I’d actually grown up with them.

I’m also really, really lucky to have a second ‘pseudo family’ who I am really close to and who seem to accept me completely which is probably the thing in my life I’m most grateful for- acceptance means a lot to me, and I’m aware I’m not always the easiest person to be around although I’m trying really hard to work on it. It’s weird but before I met them, I didn’t really think relationships were that important and although I had two close friends, they both lived far away from me and I only saw them once or twice a year. We messaged most days and were still emotionally very close but it was like a ‘virtual’ friendship rather than a ‘real’ one and for me, that was enough and I didn’t think I’d ever really need much more than that. I also had a few, very intense (mostly one-way) friendships where I would ‘latch on’ to a particular person and would become very, very close to them almost to the point of dependency until they inevitably got fed up with me and the intensity of the relationship and asked me not to contact them again. That really, really hurts and I’ve had that experience repeatedly since I was about 13 but I’m a lot more aware of it now and able to talk about it more openly and touch wood it hasn’t happened much over the last few years which is partly because I’m more able to recognise it, partly because of the ‘real’ relationships I’ve started to develop and partly because my current obsession is Homeland’s Carrie Mathison who is a fictional character and therefore incredibly unlikely to reject me. Although that doesn’t stop me from getting paranoid that Homeland producers are going to contact me asking me not to write or talk about Carrie any more because I’m too obsessive!

Anyway, back to the pseudo family relationship… A few years ago, I started to babysit for some kids I’d known from a school I worked in and who I’d got quite close to at school (I have a tendency to get a bit over-attached to kids I work with), and my views on relationships started to change. I’m not completely sure how but I was close to the kids already and babysitting meant that I developed a really nice, apparently two-way close relationship with them which was amazing. I also got on really well with their mum and felt weirdly safe and comfortable around her which doesn’t happen very often around people and I think it all kind of fed into itself so it got to a point where I realised that I felt more safe spending time with them than I did anywhere else and I loved spending time with them. And, weirdly, it really does seem to be a two-way relationship, which is very, very strange in a really nice but slightly unbelievable way.  It also really helps that, because of how the relationship developed, there were clear boundaries and even though it’s more of a friendship/family relationship now, I know their mum would tell me if I crossed any sort of boundary by mistake and that is so important in any relationship because it makes you feel safe and massively reduces anxiety.  I have a similar relationship with my best friend and I know I’m really, really lucky to have that.

Over the last few years, it’s really made me realise that genuine, two-way close relationships are actually incredibly important and that they can change and even save your life without you or them even realising it. I am not a particularly emotional person and I don’t usually like hugs or physical contact of any type but there have been some kids from school who have ‘attached’ themselves to me a bit and wanted hugs or to sit on my knee which I don’t really mind and I’ve found that it’s one of the things that can make me feel ‘connected’ or real even when I’ve been feeling rubbish and zoned out all week. I’m putting it partly down to oxytocin which I’m realising is an absolute lifesaver hormone but also down to the fact that I genuinely love the kids unconditionally. It’s a really weird feeling and it’s not something I’ve ever experienced before, and it scares me quite a lot as well as feeling intensely safe and amazing. It’s scary because of the intensity (‘good’ intensity that’s real and stable, not like the obsessive, volatile fixation I used to experience a lot) and because of the way I would do ANYTHING for the kids.  I seriously have no idea how parents manage it- it’s intense enough when they aren’t your own kids!

This is probably going to make me sound incredibly selfish (sorry in advance, but I do try to be honest on this blog) but usually most of my relationships are one-way and I’m aware of that, so it ends up being mainly about me contacting them, trying to spend time with them and, to an extent, idealising them so the thought of not being able to contact them at all is absolutely unbearable because I know (deep down) that if I didn’t contact them, they wouldn’t contact me and the relationship would be non-existent. But by that point, I’ve idolised them to an extent where that seem like the worst thing in the world so I need to keep contacting them and trying to keep the ‘relationship’ going even though I know now that they’re not real relationships because they’re not two-way and it’s more like a fixation or imaginary friendship than an actual social relationship.

With the family I babysat for, it’s different I think because they genuinely seem to accept and maybe even like me back, and (I don’t want to jump to conclusions, sound selfish or jinx anything here) I kind of think that if I didn’t contact them for a while, they would probably notice and maybe contact me or at least not forget I exist which isn’t something I’ve felt much in social relationships before. And because of that, there is so much less anxiety and paranoia around the relationship which makes a massive change from nearly every relationship I’ve had in the past. I really, really appreciate that so much and I really do love them in a way I’ve never really experienced before. It scares me that I can feel that intensely but it’s also amazing. And it’s made me realise that genuine relationships really can change your life- the kids are getting older now and are becoming more aware of mental health issues and I really, really don’t want the way I often feel to affect them which is the main reason I’m trying to hard to ‘recover’ or at least manage my thoughts and behaviours to a point where they don’t interfere with my life as much as they have done over the last fifteen years. It’s HARD but I really, really don’t want to affect the kids and I’d rather cut them off completely than risk affecting them negatively although I know that that would also hurt them so it’s a bit of a no-win situation! So I really, really need to learn to manage how I’m feeling…

The relationship with kids has also indirectly saved my life, which is another thing that scares me but not necessarily in a bad way. Since losing a very close friendship last year, I have been experiencing waves of suicidal thoughts that come and go but can sometimes be insistent and intense over several weeks and lead to repeated, vivid dreams of attempting suicide which make me feel weird, selfish and kind of jealous of my dream self and that makes me feel even more selfish and like a really horrible person. But the reason I’d never attempt suicide in real life is because of the impact it would have on the kids and that’s a really scary thing to realise. A few years ago, I didn’t even consider the effect that having a chronic eating disorder was having on my body and there was a part of me that actually wouldn’t have minded if it was severely detrimental because there were times when I would be trying to sleep feeling my heart stop-starting and ‘jumping’ in my chest from electrolyte imbalance or extreme cold and not waking up actually seemed like a better alternative to continuing to feel horrible, guilty, selfish and obsessive but now, the thought of the impact that something like that could have on the kids makes me feel incredibly selfish and guilty but in a ‘productive’ way and I really, really don’t want to hurt the kids. So I really do want to learn to manage my ED and I’m still finding ways to do that…

My relationship with the kids’ mum has also been a massively positive influence on my life and I’m really grateful for that. She lets me spend time at their house, accepts me even though she knows more about me than anyone else apart from my best friend (who I met as an inpatient and have been in psychotherapy groups with so she knows more about me than anyone else probably ever will!), and is genuinely supportive and accepting. She’s an amazing person who I really look up to and she’s a really positive role model in a lot of ways, and I really appreciate the way she’s accepted and put up with me since I first started to babysit for her. And again it’s helped me to realise how important positive relationships are in your life- I feel safer around her and the kids than I do anywhere else and I think it’s mostly because of the acceptance, positive boundaries and honesty in the relationship. Positive and trusting relationships are incredibly important for anyone, and for people experiencing mental health issues of any kind they can be life changing.

Friendships are more complicated and I’m still learning how to make, keep and manage friendship-type relationships.  Since I’ve talked about this so much in previous posts (and probably will again), I won’t go into too much detail again here but I’m really lucky to have at least one close friendship (outside of family/pseudo-family) who is amazing, accepting and so understanding of any sorts of anxiety, paranoia or intense moods which makes such a massive difference because it means I feel ‘safe’ around her and can be totally honest, and I know she would be too.  We met as inpatients so we got to know each other probably too well very quickly, but that’s one of the best and safest bases for a relationship I know.  She is awesome and I am so, so lucky to have her in my life even if I don’t see her that much because we live quite far away from each other.  As well as the Friendships and mindfulness post, I wrote a list of things I’d learned about friendships in another post and I’ll replicate it here because I think it sums up everything I’ve learned about friendships so far and am still learning…

  1. Take every friendship at face value. Don’t overthink it, make assumptions, have unrealistic or idealistic expectations, or make any judgements at all. Try to take the friendship as it comes and use mindfulness or grounding techniques to manage anxiety.
  2. Friendships are fluid and changing. There is no such thing as a ‘best friend’ or ‘forever friendship’, however amazing that would be. Enjoy the relationship when you can but don’t have any expectations that it will last forever. Practise ‘beginner’s mind’ (seeing every experience as the first time you’ve experienced it, without any preconceptions or judgements) and don’t overthink it.
  3. People change and that’s part of life. If a friendship ends, it might not have anything to do with you whatsoever- the other person might have changed or moved on and THAT’S OK. Growth is part of life and people move on at different rates. That doesn’t make it any painful, but taking away the guilt or self-criticism will help you move on from it a lot more easily.
  4. Be open with people. Honesty and openness in relationships is the most important part of a healthy relationship and will reduce anxiety more than almost anything else. Anxiety and particularly paranoia come from uncertainty and thrive in self-doubt or assumptions. If you’ve got a gut reaction to something- check it out. Don’t let it spiral into full-on paranoia or depression because then everything’s skewed through a fog of thoughts and judgements and you’re likely to damage the relationship without realising it. Sounds cliched but if the other person’s worth being friends with, they’ll be honest with you.
  5. TRUST. This is one of the hardest ones for me and there’s different ways it’s relevant to friendships but the some of the key points are to trust that the friendship will still exist even if you’re not constantly contacting the other person, trust that the other person will be honest with you, and trust that the other person really does want to stay friends with you. I find all of these really hard, especially the last one, but they’re so important and I think they get easier the more you do them… It really relates back to the mindfulness idea and I’m trying really, really hard to use that in my current friendships.

The last type of relationship I’m going to discuss is ‘functional’ relationships. By that, I mean relationships that are positive in that they have a beneficial or constructive effect on your life but you don’t necessarily need to ‘like’ the person. Sometimes friendships or family relationships can cross over into this category too but not necessarily. A typical example of this is teachers- when I was at school, I had a teacher who I really didn’t like but who was very strict and boundaried and I felt ‘safe’ in her lessons because I knew what was expected and what I was meant to do. I ended up learning a lot from that relationship about respect and fairness, and it was a constructive relationship in that sense because it had a positive effect on how I felt and behaved and it’s something I’d love to be able to model when I’m working with young people now. Another, more recent example is a psychologist I used to see in an eating disorder service. I didn’t feel massively comfortable with her and I wasn’t a big fan of her approach but I did learn a lot from the sessions even if it didn’t feel like it at the time and again it had a positive, longer term effect on how I felt. Friendships can also be functional such as people you like hanging out with but wouldn’t necessarily want to have in depth discussions with, or conversely people you trust and would go to for advice but wouldn’t feel comfortable enough to spend a lot of time with. Relationships aren’t binary and can merge into different categories but the main differences are whether they’re positive or negative, and how close they are.

Another type of relationship that isn’t mentioned as much as it should be is human-animal bonding which can be just as useful and important as human-human social relationships.  I have had cats since I was in primary school and, growing up especially, this has been a really, really positive impact on my life.  Until recently, pets were the only ‘beings’ I’d ever said “I love you” to, and I get the same oxytocin release from cuddling my cat as I do with kids I babysit or work with.  Oxytocin is a really, really powerful hormone and massively underestimated- it can more powerful than any mood stabiliser, promotes the strongest feeling of acceptance and safety I know, reduces anxiety and depression, and is the best cure for loneliness I’ve ever come across.  This is why pets can be vitally important for people at risk of social isolation and for anyone with or without mental health issues.  I love my cat so much and can’t imagine not having one- to the point where, after my previous cat died and my parents didn’t want to get another one, I waited until they’d gone away for a week before going to cat rescue and adopting one who is now my ‘cat-baby’ and I really, really love her.  It’s amazing how much cuddling her and feeling her purr can affect my mood, and it’s the same tingly-chest feeling I get from hugging the kids.

Writing this post really reminds me of a verse from David Bowie’s song ‘Five Years‘ which is written about alienation of society and the whole song is based around the idea that the world will end in five years.  He sings “And all the fat-skinny people, and all the tall-short people, And all the nobody people, and all the somebody people, I never thought I’d need so many people.”  This line really gets to me because I can completely relate to how that feels, and ten years ago I’d never have thought I’d have the sort of social relationships I have now, or how much I would appreciate and ‘need’ them.  The Ziggy Stardust album is written about an alien rock star and Bowie inhabited Ziggy as a character while writing and performing in the early 1970s, and that means that the lyrics and concepts are intense and real, and a lot of the songs are written about alienation, fragmentisation and the way in which people are dissociated from each other.  Bowie’s albums nearly always deal with this idea, and a lot of his exploration seems to be about characters feeling alienated in some way and how destructive or dangerous this can be.

For people with mental health issues, relationships are particularly important because they can reduce the risk of social isolation or exclusion, which can exacerbate existing issues such as depression or paranoia. It’s a lot more complicated in practice because many mental illnesses can lead to a person self-isolating because of lack of motivation or energy to go and meet people, anxiety about being around people, paranoid thoughts or any combination of factors and also because there is still a lot of stigma about mental health issues and some people are judgmental or just scared of it which again leads to people experiencing mental health issues to become isolated or lonely. But positive relationships can be as beneficial for people with mental health issues as medication or therapy if not more beneficial and it’s so important to raise awareness and understanding of mental health as a spectrum, how to accept and support someone experiencing mental health issues, and the importance of developing and maintaining positive relationships.

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