It was last week that Halina Rifai resigned from her job. It was a short-term contract she’d taken on about a month ago, working for a call centre, but it was stressful, and meant working long hours at home, leaving her unable to get outside much during the day. Last week, she woke in the middle of the night and had a panic attack. “And then the next morning, I just went: ‘No, that’s it, I’m going out.’” She went for a six-mile walk before work, felt much better, but also knew that she had to make a decision about work. “It’s at this point that I have to weigh up my mental health against finance, and I have to choose my mental health,” she says, though she acknowledges she is lucky that she has another job lined up for early next year.
Rifai, from Glasgow, works in the music industry during non-pandemic times, and also hosts a mental health podcast, A Sonic Hug. At the age of 16, she was diagnosed with post-traumatic stress disorder after growing up in an abusive home, and at 20, she was having panic attacks and had developed agoraphobia. She has had treatment, including long-term talking therapy, which finished earlier this year, but she has learned to manage it largely herself – making sure she watches out for any signs that she is sliding back.
“I started to get those feelings last week,” she says. “There’s a terrible uneasiness. There’s this nervous energy, your thoughts are darting about considerably and you can’t concentrate on one thing. I get extremely irritable and overwhelmed by everything and there’s a feeling of complete hopelessness.” There are physical sensations, too – her heart races, and she feels hot. “And just a detachment from reality, and becoming quite paranoid about things.” Although it’s tough to experience, it is, she says, “a godsend that I know what’s happening now”.
For those of us not so in tune with signals that our mental health is suffering, it can be hard at the moment to know if something is becoming a problem. In this pandemic year, says Ann Robinson, a GP and writer, “the usual signs of depression and anxiety are muddled and difficult to tease out”. Symptoms are different because of the effect the pandemic is having on our daily lives. Many of us are experiencing signs of depression or anxiety to some extent, but, Robinson points out, “we’re not all necessarily clinically depressed or anxious”.
Experts have predicted a mental health crisis this winter, and the Centre for Mental Health, an independent UK charity, predicts that in England up to 10 million people will need support as a result of the Covid crisis. Although we should be wary of diagnosing ourselves or others with mental health disorders, we can watch out for signs. The problem is it can be difficult when we’re not around the people who might spot something is off – our family, friends or colleagues – and it can be hard to know what is a cause for concern, and what is an entirely understandable response to unprecedented times.
“For instance, if you are feeling very sad,” says Robinson, “you would normally measure that by saying you have no plans, that you’re not looking forward to anything in the future. That’s quite rational at the moment. In fact, you could say it was irrational to be making too many plans.” Instead, says Robinson, “ask yourself whether the things that usually lift your spirits, like a walk in the park, or chucking a stick for your dog, are failing to”.
Another sign of depression may be feeling confused or being unable to concentrate. “Normally, you might judge that by asking yourself if you can focus at work,” she says. “But everyone’s finding it hard to focus on Zoom now. So perhaps a better measure now is: can you stick with the plot of a book? Can you follow a TV drama? Or do you find that you just can’t concentrate because of the intrusive and negative thoughts?”
Excessive fear or worry is a sign of an anxiety issue, but again, says Robinson, we’re living with scary news and who is to say what is excessive? “So ask yourself: is it becoming overwhelming, is it constant and is it a greater fear level than other people seem to be experiencing?” Another sign of depression and anxiety is a withdrawal from friends and activities; hard to judge when large groups are banned and there are ongoing restrictions on contact. “So the question to ask yourself is: once the opportunity does present itself – and in a limited, more muted way than previously – am I still able to motivate myself to see people?”
Another telling sign during pre-Covid times is feeling excessively tired and having problems sleeping. “Again, a lot of us have found that our energy levels, enthusiasm for life and ability to sleep well have been impacted on by the current crisis, and that’s a normal reaction to a very abnormal situation,” says Robinson. “But if it is affecting your life to the extent that you can’t get things done that need to get done, you can’t get the shopping in, you can’t bring yourself to eat or you’re overwhelmingly tired during the day so that you can’t function, these would be warning signs to seek help.”
Is not wanting to go out, or use public transport, a sign that you’re being sensible and following advice, or related to a deeper anxiety issue? The test, says Robinson, is when things start approaching something more normal and “whether people find that they’re excessively fearful of outside contact. Just being wary about public transport doesn’t mean you’ve got a mental health disorder. Nobody should be worried if they remain wary about things like public transport or crowded spaces for some time to come. That’s a highly likely and very normal adaptive response.”
The line we should draw, says Robinson, is about how we are functioning and the impact on our wellbeing. “We’re all living a lesser, quieter, more muted existence but there’s a difference between that and tipping into a clinical depression and anxiety, and the difference is to do with functioning.”
Chi-Chi Obuaya, a consultant psychiatrist, talks about “thriving and languishing. When one is thriving, there’s that ability to be outward-focused, optimistic, to pay good attention to sleep, nutrition and exercise levels. Generally, your mood is going to be on the brighter side; anxiety may come but the levels feel manageable. Conversely, when one is languishing, sleep is impaired, mood may fluctuate and anxiety levels are persistently high. There’s more of a ruminative thinking pattern, so constantly worrying about specific themes. And there’s an inward focus. Those things may indicate that someone needs additional support.”
The core symptoms of depression, he says, “are a low mood, a lack of energy and an inability to enjoy previously pleasurable activities. Alongside that, there may be disruption in sleep, appetite, concentration, and thoughts of not wanting to be alive or thinking very pessimistically. Whereas for anxiety disorders, I would want to emphasise that anxiety is a normal phenomenon, and the presence of anxiety doesn’t necessarily indicate that there’s definitely a mental health condition.” It’s when it becomes pervasive and has an “impact on our day-to-day functioning. So being able to attend to our personal hygiene, to cook, clean and to manage our finances, and our relationships as well. If we’re becoming very withdrawn, this also indicates a level of severity that probably warrants some input.” However, he points out, “everybody is different. Some people are more introverted, others are more extroverted, but the key baseline is what’s normal for you?”
Sarah Benjamin, whose health problems forced her to retire from her career as a consultant neonatologist, which led to depression, recognises the signs that her mental health is declining. A voracious reader, she notices that, during low periods, “I found that suddenly I wasn’t reading and I thought: ‘This is very odd. Why am I not doing what I always do?’ I’d start and I couldn’t concentrate. Sometimes, I couldn’t even pick up a book.” A few years ago, she started to learn to play the guitar and not wanting to play is another sign. “I haven’t played the guitar since lockdown. It’s something that I really enjoy, but I can’t kind of get around to doing it.” During low periods, “I tend to hide away a bit and not seek out friends I would normally see, I’ll find excuses why I can’t see them. So I know that I’ve got to force myself to do something.” Her amateur dramatics group has been incredibly important, giving her the opportunity to meet people “and just be silly”, but obviously it hasn’t been running this year. Keeping in touch with friends online has helped, says Benjamin, but it’s not the same.
Rifai, who experiences social anxiety, has actually enjoyed aspects of a quieter, less social year. It was taking on that job that created stress and anxiety. She knows that exercise – particularly walking – works for her, “and cutting down things like alcohol, and keeping really hydrated. Hydration was one that I realised, just from experimentation, is key for me. I recognise now that I have dips and I try not to let that overwhelm me. I try not to punish myself and say: ‘You’ve failed again, you’re going back to where you were.’ It’s just like: ‘No, this is just one of those days and you just have to work through this.’ And it’s on an hour-by-hour basis at that point.” She would seek help, she says, “if it got to the point that I wouldn’t be able to manage it myself”.
Contact your GP or NHS 111, says Robinson. “The charity Mind has an excellent website and you can access online tools through them,” she says. “You should be wary of just randomly Googling mental health apps because some are better than others.” There are other places to get support, such as Samaritans. “I would emphasise that it’s been an unprecedented year, which has presented challenges in all sorts of ways,” says Obuaya. “Therefore we shouldn’t make the assumption that because somebody is experiencing difficulty, or a degree of adversity, it necessarily indicates they’ve got a major mental health problem.” But, he stresses, there is “a range of help. I would encourage people to reach out.”
• In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978
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