The public health issues gripping the world have been hard on a lot of people – indeed, I would be surprised to find anyone who hadn’t experienced some sort of negative impact from the changes that Covid-19 has worked upon our lives. I’m sure, here in the UK, we’ve all heard from friends and relatives finding themselves homeschooling their kids with very little notice and usually equally sparse support. I expect more than a few of my readers have been in that position themselves, not just heard about it at one remove. People who have lost their job or had hours cut have obvious stress. People who thrive on social contact will have struggled with the limited ability to see other people. People who have had to restrict contact even more because of being at high risk, such as the UK’s ‘shielding’ category, will have had extra stress just getting essentials, and those who already relied on shopping deliveries have had to cope with slots being much harder to come by.
Those are the obvious sources of stress, of things that can affect people’s mental health. And those are just the tip of the iceberg.
You’ve probably seen affirmations about this online – I’ve certainly seen a lot of people sharing them on social media. You’re living in a changed environment, you’re living through things utterly outside of your previous experience, this is stressful, it’s okay to not be coping well. It’s a simple fact of which those experienced in mental health – on either side of the desk – will be well aware: stress, from any source, will potentially exacerbate mental health problems. Lots of physical health problems respond to stress as well, of course, but that’s a whole other topic. People who are prone to depression or anxiety, but usually keep it under control with medication or strategies learned in therapy, are likely to find it rearing its head. People who experience less common or well understood mental health problems, like PTSD or anything under the category of ‘severe and enduring mental illness’, are likely to find their symptoms worsening due to the stress. People who have mental health problems that are sufficiently mild that they’ve never had any attention for them – and my personal feeling is that this covers an awful lot of people – or those with mental health problems from which they considered themselves entirely recovered will, in many cases, have found things suddenly intruding into their life, and the way it affects them won’t necessarily have any obvious connection to the pandemic.
Contents:
My Mental Health (and some background theory)
I have bipolar 2 disorder (also written as bipolar II disorder, and sometimes referred to as bipolar type 2). A lot of you will certainly have heard of bipolar disorder, though understanding of it is less common. It’s a condition in which a person has episodes of ‘elevated’ mood (often used in summaries, but misleading) and episodes of low mood. The ‘up’ episodes are called manic or hypomanic (essentially ‘not quite manic, but going in that direction’), while the ‘down’ episodes are called depressive. In bipolar 1, both manic and hypomanic episodes occur; in bipolar 2, full-blown mania does not occur, though the precise definition of the dividing line between mania and hypomania varies between sources and is rarely terribly clear. What is broadly agreed upon is that a manic-type episode in which you become very dysfunctional to the point that hospital admission might be considered is full mania, any with psychotic features is full mania, and anything else may be hypomania – but there is a bit of a grey area between things universally agreed as mania and things universally agreed as hypomania.
In between such episodes, the textbooks say that a person with bipolar disorder is euthymic, or essentially ‘normal’ in mood. That means they respond to emotional stimuli and situations within the range of typically expected ways, that they are at times cheerful, that they enjoy their normal activities, that they are reasonably enthusiastic about some things, and so on. The psychiatrist who revised my diagnosis (it had previously been depression, with various adjectives like ‘recurrent’ prepended to it at different times) explained to me that this is an ideal description that is not entirely reflected in practice – some people with bipolar disorder tend to be dysthymic, at least at times. This refers to a mood state that is on the depressive side of euthymia, but short of anything that would be clinically classified as depression. According to the textbooks, that ought to lead to a dual diagnosis of dysthymia and bipolar disorder, but in practice that doesn’t seem to happen much.
Another feature that commonly co-occurs with depression or bipolar disorder is anxiety. Everyone has anxiety some times over some things, it’s a perfectly normal state to be in, just as it is normal to be unhappy, even very unhappy, at times. Anxiety disorders occur when anxiety is occurring in a way that is not an appropriate reaction, either in terms of anxiety occurring in relation to inappropriate stimuli or the degree of anxiety being greater than would reasonably be expected. People might experience social anxiety, anxiety in relation to interacting with other people, or they may have a phobia, an excessive fear reaction to some particular stimulus. They might experience generalised anxiety, a state of being anxious with little or no provocation that persists or recurs. Some of the time these anxiety responses are symptoms of some specific condition, and sometimes they are considered a separate disorder of their own. Anxiety is a fairly common feature of hypomanic or manic states, for instance, though both may alternatively involve a sense of fearlessness. Anxiety can be very debilitating, but recognition of it as an issue separate to any co-occurring depression or bipolar disorder is very variable.
Getting back to the specifics of my own experience, the usual treatment pathway for bipolar disorder involves a medicine to stabilise moods, usually lithium or an antipsychotic. Sometimes an antidepressant is used as well; there seems to be some disagreement in the profession as to whether this is advisable in all cases, some cases, or never. Most antidepressants have an interesting impact on bipolar; they make you have shorter and more frequent episodes, a feature termed rapid cycling. As such, wherever a professional stands on the use of antidepressants in bipolar disorder, they usually say they shouldn’t be used in the absence of a mood stabiliser. Because I’d been diagnosed with depression, however, I’d been on antidepressants for years, and felt better on them (when we found one that worked) than off. So there I was, talking to a psychiatrist who had just diagnosed me with bipolar, and we got to talking about medication.
Turns out the way I react to antidepressants – getting a seemingly positive impact from them relatively quickly especially – was another indicator of bipolar disorder. What’s actually happening is the rapid cycling, which often starts with a relatively solid bout of hypomania. It would have been nice if anyone had noticed that before, like maybe the first time I started them, as a sixteen-year-old psychiatric in-patient who had a massively improved mood within a week, and looking back I recognise that I was hypomanic at that point. That personal gripe aside, this was very interesting. We talked about medication, and looked at all the other meds I was taking. As some of you may have gathered from some things I’ve written before, or if you’ve met me, my mental health problems are just one small slice of my health problems, and I take a fair amount of medication for other conditions. There were particular concerns about adding extra psychoactives given my narcolepsy medication especially. The psychiatrist was very reticent to give me other medication if I was, all things told, managing to get along with my mood disorder with social support at home and so on.
That is the wisdom that has prevailed to this day, and I don’t disagree with it. My wife acts as a great buffer, stopping there being too much in the way of long-term consequences of either depressive or hypomanic episodes, and the rapid cycling at least means that episodes are short-lived, even if there are more of them. A few weeks ago, I had an incredibly bad depressive episode. I mean complete disinterest in anything, negative thoughts I couldn’t escape, persistent thoughts of self-harm. One of the worst I’ve had in a long time. It lasted one day. I wish it hadn’t happened, but I sure am glad it wasn’t more persistent.
It’s also worth mentioning that I’m currently on the waiting list for an adult attention deficit hyperactivity disorder (ADHD) assessment. Note that it’s the assessment that ‘adult’ describes – the condition is the same in children and adults, though it can end up looking different due to different responsibilities, experiences, and time to learn coping strategies (even if they aren’t optimal ones). It looks like this may have been missed in my childhood for several reasons, one of which is that it just isn’t spotted as readily as it is now. Even now, though I could quite easily have been missed, as I never did badly at school, and I wasn’t really disruptive. My mum and I worked through some of the questions used in assessing it, and there were a lot of “oh yeah” moments – my primary school teachers complaining about me staring off into space, my tendency to crash deadlines, my intermittent talkativeness, my difficulty sitting still, my need to always be occupied (though fortunately reading counted – though sitting still was still unusual). Meetings for Worship are actually hard for me for a number of reasons, and some of them are things that led to me asking for the ADHD referral.
ADHD is widely misunderstood, which is one of the reasons that smart, not-terribly-disruptive kids get missed. It doesn’t mean an inability to pay attention, even in the classic inattentive type; it doesn’t mean constant movement, even in the classic hyperactive type. It does, on the inattentive side, mean a tendency to be distractible, or to distract oneself by noticing little details or getting curious about minor points, but is often accompanied by a pattern known as hyperfocus, in which it is very difficult to distract the person, and they can often be very productive at what they are focussed on, inasmuch as that thing can be said to be productive. Hyperfocus is more likely on a topic or activity that interests the person, which can lead to some diagnostic overlap with autism spectrum disorders (ASD), and indeed rates of ASD among those with ADHD diagnosis are higher than in the general population, and likewise rates of ADHD among those with ASD diagnosis. As far as I’m aware, though, most people with ASD do not have ADHD, nor vice versa.
Hyperfocus isn’t always about interest, though – sometimes it seems to be more or less random, a matter of what one’s brain is willing to focus on at a given moment. And a lot of the time, hyperfocus isn’t there if you want it, and it’s a struggle to get your brain to stay on task, especially if the task isn’t terribly stimulating.
Likewise, the need to be active that is reflected in the term ‘hyperactivity’ is not always physical; it is the need to be occupied in some way, to be doing something. I understand some people with ADHD describe their hyperactivity as a purely mental thing, for others it is purely physical – they struggle with physical stillness in any situation – but for many it’s a bit of both. Assuming that my difficulties in this area are attributable to ADHD, in my case it is both. The need for mental occupation is constant, absent enough psychoactives to make mental activity fairly futile. The need for physical movement is different; most of the time just fidgeting or doodling is enough, but after a while – and how often it is varies from day to day – I just have to get up and move around. Indeed, sometimes when I am having difficulty focussing attention where I want it, getting up and doing something physical (preferably something productive) will help settle my mind where I want it once I’m done.
The real heart of my experience is that I can’t do what most people are apparently able to do – I can’t do nothing, whatever the environment. Sunsets on beautiful countryside are nice and all, but it takes a little while to look at it and take in all the detail and then it’s done, my mind has to move on to something else. People who lie down sunbathing, wide awake, baffle me. I’m sure they aren’t literally not thinking anything, but it seems like they can slow their thoughts down to just drift along in idle musing. My musings are rarely idle; they race at breakneck speed, branch out into related topics. I go off on tangents very easily, too – that’s the distractibility, but happening just in my own head, and it can make conversations quite odd. Hopefully, my process of self-editing in my writing makes it less obvious, but it’s something people who speak to me in person a lot have commented on.
As a side note, it’s worth noting that this idea of being unable to ‘stop thinking’ is not unique to ADHD. It can very much be a characteristic all on its own. Other things that go with it, and the way the thinking goes, are more specific to ADHD.
The
Pandemic
So that’s some theory covered, and some background about me. Now to get on to the hot topic: the pandemic. We’ll start with some general points, but then it’s going to come back to me – not because I love talking about myself, sharing this is a very difficult thing to do, but because it’s what I can speak of with great authority, and it’s what gives me some of the insights I’ll come to later.
Everywhere seems to have been putting the public under some restrictions during this pandemic, whether simply a matter of public health advice – hopefully backed up by social pressure – or that combined with some restrictions enforceable (if not always enforced) by law. Here in the UK we had quite a long period of lockdown, during which it was only legal to be out of one’s home for certain prescribed purposes, and initially the advice was not to go to work unless one’s workplace was doing something vital (including, for example, producing or selling food, as well as many forms of public service work) and it was impossible to do your job from home. Gradually more work-places were encouraged to re-open, though working from home where practical has been consistently encouraged. Social mixing was effectively banned for a time, with gradually increasing permission to meet outdoors as long as there were sufficiently few people from sufficiently few households, and you kept your distance. Eventually, as cases declined, indoor mixing in public places was allowed, depending roughly on the case rate in your local area (for some value of ‘local’, more on which below) and thus which ‘tier’ of restrictions you were in. That then reversed as cases resurged, of course, and we ended up with another period of lockdown, with hospitality shut down again, and everyone urged to work from home if possible.
During the full lockdown, people with certain health conditions and/or taking certain treatments were advised to ‘shield’, a practice shared with other countries under various names (I believe Ireland advised them to ‘cocoon’). The idea of this was that people at particular risk of severe complications of Covid should take fairly extreme measures to avoid it – including socially distancing from the rest of their household, and using a different bathroom. They noted that a thorough clean between uses would allow use of a shared bathroom, which makes one wonder how familiar the people writing the rules were with the number of people living in homes with only one bathroom – including just the one toilet – or with how much work it would be to clean the bathroom thoroughly enough to meet the standards they were setting out. People who were shielding were to not leave their home at all (later modified to allow going out for exercise as long as they never went near anyone at all while out), and keep a minimum 2 metres distance from even those they lived with – again, not practical in the housing that most people live in.
Of course, masks soon appeared, and were required before long to use public transport or go into a shop or similar. There were and are no rules about what sort of face covering is sufficient, though there is advice as to the composition. Last I heard, it was a hydrophobic (usually meaning synthetic) layer on one side, and a hydrophilic (usually meaning natural fibres) layer on the other, with a non-woven (ideally synthetic) layer in between. This arrangement had been found, in rapidly-executed testing, to be best at capturing the full range of droplet sizes that can spread Covid, as those droplet exit through the mouth and nose; wearing a mask is not to protect yourself (though the big plastic visors can help with that somewhat), but to protect others (which the big plastic visors do near nothing to help with). At a pinch, though, you meet the legal requirement with a scarf, or even a snood or a Buff® (other cylindrically-woven high-tech head-and-neck garments are available, this is not a paid promotion).
The Pandemic and Me
The Shielding list was first put together based on prescribing data – who had had certain medicines prescribed how recently – and GP patient coding data – who was coded with what conditions. I was placed on the automated list thanks to slightly out-of-date data, as I had been prescribed the immunosuppressant I had just stopped taking recently enough. Clinical discretion was also applied, with GPs and specialists able to put people on the list, or take them off it, and when my dermatologist applied their clinical discretion, they put me on the list – and say I still need to be on it now, presumably because it’s unclear if the immune-modifying medication I now take is a problem, and I have a milder risk factor (asthma), so better safe than sorry. Being on the Shielding list had some advantages. We got calls from the council to make sure we were okay, and were offered food parcels. It was also supposed to lead to easier access (or access at all) to online grocery delivery slots, but it turns out they only gave you that if you said ‘yes’ to the food parcels, and we didn’t because there would be a lot of processed food in it, and chances are one or both of us wouldn’t be able to eat a fair proportion of it – and we could certainly afford to pay for our own food in any case.
So this meant that all our groceries had to be gone out and bought, and I had to stay in. I’m usually the one that does the going out – while my wife and I both have limited mobility, if she pushes her physical activity she’s usually fairly wrecked with fatigue for the rest of the day, while I can recover enough to do things that don’t require me to do any more moving around fairly quickly; I also (usually) have less of a psychological problem being around other people. This meant quite a change in the division of labour at home, which took some time to settle into, but we managed quite nicely all told. Certainly it took a physical and mental toll on my wife, and I was as supportive as I knew how to be, but I seemed to be getting along okay mentally.
It also didn’t make much difference to how much I saw local Friends, or any of my non-Quaker friends, because I hadn’t been much for a little while. As we settled in after moving last summer, with being further from the Meeting House, I’d not been making it to Meeting for Worship very often, though I had been making Area Meeting, and of course meetings of Trustees, what with me clerking them. Trustees’ meetings moved online, naturally, making use of the suddenly-popular Zoom video-conferencing service. And, to my everlasting regret but for complicated psychological reasons, persistent inability to remedy, I have rarely seen my friends, even those in the area, very much. The intercepted food club I helped run shut down; the work has been centralised into a new local charity, though we intend to run a separate club ourselves once it’s possible again. So I suppose there was that one weekly contact with a whole lot of people, most of whom I was friendly with, though none that I was close to, that I lost.
That all seemed okay, though. I actually ended up in better contact with my local friends, a social circle deriving from university (a lot of us stayed in the area), as some of them set up a Discord server (an instant messaging and audio chat system originally designed for people playing video games; look it up if you want more details) and I got onto that. That hasn’t turned out to be an unalloyed positive, but I shan’t get into that – it would require things that involve other people, and some really deep delving into aspects of my mental health problems that I don’t care to get into here, as it would distract from the current topic – a topic that, without tangents, will have this as one of the longest posts on my blog in any case. I felt like I was doing okay. I wasn’t worried.
My wife was worried. She was worried about me doing less in the way of thoughtful, involved social activities. She pushed me to go to Meeting for Worship on Zoom, but she has her own limitations, and had her own stresses from the whole situation, some of which are mentioned above. She tells me that, in hindsight, she thinks maybe she should have pushed me harder, but it’s hard to know if that would have worked. Perhaps, if we’d known in the summer how things would go on for the rest of the year – the continuing, changing restrictions, the stress of worrying about people close to us for so long, the actual experience of people we knew, albeit that we weren’t close to, dying – the priorities might have been different.
I started falling behind on some things. My attempts to get back up to tempo writing this blog faltered, my work for Trustees became unreliable. It’s not that I was entirely unproductive; once my work figured out how we could continue by audio conference, I was doing more work than before, and while I no longer had to travel to the various sites at which I would normally be working, I still had to do as much, in fact more actual work, as I was allocated more work. And my wife and I were – are – still sorting out the flat we’ve now been living in for nearly 18 months. Still, that couldn’t explain the drop-off in my other activities. So I fell behind.
There’s a thing that happens to me sometimes when I fall behind at something. Sure, sometimes I get my rear in gear and catch up, but more often I develop an aversive, anxiety-based reaction to the thing I’ve fallen behind in. Which makes me fall further behind. Which makes the aversion worse, and indeed spreads it to related areas. Still, it wasn’t too bad, it was at a point I could turn it around from.
Then I was ill. I have a chronic balance problem, which is the main root of my physical mobility problems. This started as a bout of vestibular neuritis some years ago – not my first – that never went away completely. Since then, I’ve had infrequent new bouts, and this summer, I had one. Didn’t seek any medical attention for it – no point, I have the symptomatic treatment on repeat prescription for occasional use, and there’s nothing else they could do about it, and doctors were quite busy enough as it was. But it meant I had several days of barely being able to spend 10 seconds far off horizontal, and then a couple of weeks or so of my balance gradually getting back to normal.
I didn’t get much done in that time. I was just lucky I didn’t have any paid work to do then.
At the end of it, though, I was even more behind. Horribly behind, both external expectations and my own aspirations. The only thing that wasn’t screwed up was my main paid work, and that was pure luck. Every other area of my life, I was well up a certain creek without any means of propelling my canoe.
The anxiety became awful. Crippling. It was so bad that it actually got in the way of me telling anyone relevant about it. I only told the rest of the trustees’ clerking team about it when they started asking, “hey, when are we going to work out the agenda for this meeting next week?”. I was in a state where I couldn’t think clearly about anything for very long (possibly related to the possible ADHD, but of a whole new order of magnitude), and for those things particularly stressing me, I could barely focus on them at all. All the things I should have done, should be doing, all the mistakes I’d made, everything I’d screwed up – even going back before the current crisis – would pile in on my thoughts.
There were some absorbing activities that could reduce the anxiety, stop my heart racing so fast, stop my head spinning, but not enough of them were productive. I could load and unload the dishwasher, do the small amount of washing up that doesn’t go through the dishwasher, tidy things away if I knew where they went. As long as it didn’t involve leaving the flat, required attention but not critical or creative thinking, and wasn’t related to my main stressors (which kept multiplying), I could do it and it would absorb me. Some things that require real thought I could handle some of the time, like cooking, but the kind of cooking I love to do isn’t very compatible with my physical limitations, so there was only so much time I could spend on that – and only so many containers and so much freezer space for the resultant batches of food.
Video games were a welcome respite, but of course the only way they could be said to be productive was that they absorbed me enough to actually put some distance between myself and my thoughts. My main paid work I could only do for so long before the anxiety-related thoughts crowded out the work I was doing, and I could play a video game for a little while and it would clear my head. I could do a tiny bit of the real anxiety-inducing stuff and then bury my head in a computer game until I calmed down. Reading has, for a long time, been one of my major ways to occupy my head and get away from whatever is bothering me, but it required too much focus to do for long. TV and films, well, I have trouble putting much attention to them at the best of times – they just aren’t interactive enough, mentally speaking, for me to do them without doing something else as well (I do wonder if the main reason I always want popcorn at the cinema isn’t how great popcorn is, but that it gives me a socially acceptable fidget), so the TV isn’t really doing that much to help distract me – though we did get through an awful lot of MasterChef Australia on Amazon Prime Video. By which I mean all of it.
My cooking did improve.
Once the rest of the clerking team knew what was up, they were understanding and supportive. I was encouraged to seek help, which I was doing anyway. My GP gave me some short-term symptomatic relief with medication – medication they don’t hand out lightly. I self-referred, with their encouragement, to the local primary care psychological therapies service, Minds Matter (for those who know about the UK health service, this is the local IAPT – improving access to psychological therapies – service, which has improve access in terms of people being able to get help, but the minimum range of services has become the maximum range, so some treatments are less flexible than they once were). I’ve now been referred on to them for medication and general review with the secondary mental health care service (the Community Mental Health Team, or CMHT – the service that provides hospital-type care within the community), for which I am now awaiting an appointment. The person at Minds Matter doing the initial assessment (over the phone, naturally) was particularly interested in the fact I’d never had any treatment, pharmacological or otherwise, for my bipolar disorder, and thought that IAPT Step 4 treatment, a stage reserved largely for what are termed ‘severe and enduring mental illnesses’, like bipolar and schizophrenia, would probably be most appropriate. Dealing with the anxiety on the surface while the underlying chronic problem was perhaps undertreated was, they thought, unlikely to be helpful.
That’s only available if you are under the care of the CMHT, however, so on my referral went. I had an initial chat with with someone from the START team (specialist treatment and rehabilitation team, whose role is partly as gatekeepers for the CMHT), who booked my an appointment for a longer assessment by phone, then called back after reading the notes from Minds Matter and said it would go straight to team review and, they expected, on to the CMHT. Then I’ll have a general review, and possibly get that Step 4 talking treatment. Maybe we’ll decide – I’m a firm believer in collaborative decision-making in healthcare – to adjust my medication, maybe I’ll try a mood stabiliser, but the situation of me being on so much other medication hasn’t changed, so I’m not enthused with the idea, and rapid cycling isn’t always a bad thing.
Anyway, my appointment as Clerk to Trustees is up at the end of the year, and I am not being re-nominated. I continue as a Trustee and as Data Protection Officer for at least one year. Two short meetings of Trustees were held without me, and I stepped up and did my job for the final one, earlier this month. I coped okay. It helps that medication I was given to try for another problem is also somewhat effective against anxiety. I’m still more emotionally labile (which is to say my emotional state shifts easily, sometimes excessively, in response to stimuli) than usual, and I’m still prone to feeling surges of anxiety about some particular thing, or nothing. I have developed a quite specific and irrational aversion to the bin room in our building, so I still don’t manage to take rubbish or recycling down alone – I can’t say there’s anything in there that particularly scares me, I’m just overcome with anxiety at the thought.
My strongest aversive anxiety reaction is still to Quaker-related things, especially my Local and Area Meeting, though they did nothing to deserve that. Speaking to the Mental Health Forum was a big hurdle for me, but one I felt better for doing. Preparing to speak at that online event was the first time I put all this in order and really confronted what has happened, how I’ve been affected. I still don’t really know the ‘why’, but exploring the ‘how’ has been stressful but beneficial. This post is in part written from the notes I made for that event, which brings me on to the final section – what Quaker communities, or indeed any spiritual community (or perhaps any community) might learn from my experience, about how we support and care for one another and about living with members with significant mental health problems.
What
Communities Can Learn
I do want to be very clear that no-one other than myself did anything they shouldn’t have, or failed to do something they should have. However, the experience can give pointers to some extra things we can do, or some differences in attitude that might be helpful.
My starting point here is that a spiritual community is a community, and a community has to be concerned with the welfare of those who are part of that community – it is, I would argue, inherent in the idea of community. In a spiritual community, that particularly includes spiritual welfare, but mental health is not an especially spiritual concern – it is, or should be, a mainstream concern. It can interact with spirituality in ways that physical health does not, though both physical and mental health problems can cause difficulties for participation in any given activity. The ways that physical health problems are likely to get in the way of participation in Quaker spiritual activities, such as Meeting for Worship, are fairly obvious, or at least they should be; the ways that mental health problems get in the way of those activities are more subtle, though I have touched on the subject before.
Another starting point is the Quaker maxim that we seek to do what love requires of us. That doesn’t always have to involve deep, spiritual leadings or careful discernment. Sometimes it is just common sense. It should take no reflection to realise that we should come to the assistance of someone who is physically injured, though reflection – or simply knowledge and experience – might be necessary to work out precisely how we assist them. It is no different when someone is suffering mentally.
A lot of people mask mental health problems. Sometimes it’s deliberate, to avoid stigma, or just to avoid bringing other people down. Sometimes, as in my case, it’s instinctive, and very hard for me to drop the mask. What this means is that, even if I am suffering quite badly, when I actually interact with people I may show no sign of it. There are very few people that don’t prompt that mask to come on of its own accord, and even with my wife it comes on a bit sometimes. However, just because it’s not deliberate, doesn’t mean it takes no effort. It is mentally exhausting. So a lot of us will avoid interacting with people when our mental health isn’t doing so well, even if just to avoid that exhaustion. It doesn’t just apply to mood disorders, like depression or bipolar; people with schizophrenia that is more ‘active’ than usual for them also mask – especially if they have good insight, but sometimes even if their insight is poor. It doesn’t take much insight to develop the instinct that people respond negatively towards you when you explain how, for example, the government is keeping an eye on you to make sure that you don’t share details of the mind control experiments to which you were subject.
Even knowing all that, it is hard to reach out to people who you think might be in distress. I don’t just mean that the prospect can be daunting, though it certainly is; when you try to reach out to us, there’s every chance we won’t admit there’s a problem even if there is. There’s also a natural desire not to wish to intrude. I don’t pretend there are easy answers, but doing something will usually be better than doing nothing.
There are things about the Religious Society of Friends that make the whole situation even harder – not things that are necessarily unique to Quakers, but relatively unusual in terms of the spiritual communities with which the wider community are more familiar. For instance, we rely on members of the community as volunteers for a huge range of things, not investing particular pastoral authority or responsibility – in either of the senses it is used in ‘mainstream’ Christianity. That means that we have particular difficulties when there is widespread stress, such as during a pandemic. Everyone might have trouble keeping up their own responsibilities, and struggle to do more to help those who need help. It also means that, if someone has a serious problem, then things just don’t get done, and other people don’t always know about it. That can be a big deal, especially for some roles (such as, for example, clerk to Trustees).
It’s also inescapable that some of the language we use, some of our popular writings, can be taken to suggest that someone who is properly in touch with the Spirit will experience personal tranquillity. There’s some that says the opposite, too, and much that can be read in a number of ways, but it’s hard to predict which attitude might have been internalised by any given person. This then serves as an extra factor holding people back from seeking help.
If you realise that someone seems to be drifting away from the community, or at least from their usual contact with the community, try to understand why it might be. If you know they have mental health problems – some of us are quite open about it – then this should be, if not a red flag, at least a yellow one.
Communities are defined by people doing things together, which is possibly even more fundamental than the idea of supporting one another. That doesn’t necessarily mean physical co-presence; There are a wealth of online communities out there who are defined by shared interests, activities, and mutual support, where people being in the same place as one another is rare, from those engaged in collaborative open-source software development to the fan communities for books, films and TV shows. But the activity needs to be shared, needs to be done in some way that has a sense of collaboration, if not co-presence (of physical or virtual sort), for it to be part of building community. This is ordinarily no problem for a Quaker community, barring individual barriers, as we get together for Meeting for Worship. When we can’t get together physically due to the prevailing circumstances, we must find new ways of doing it, in which we are still doing it together; essentially the same question as to how we keep people involved who are prevented from attending Meeting for Worship, but applied to the community as a whole.
That may pose extra barriers for some people, but we must do what we can to involve people in shared activities of some sort when they can’t be involved in the usual way – whether that’s because of the general circumstances, as in a pandemic, or because of their own circumstances, as in disability (including mental health difficulties), or the combination of the two.
It is also worth noting that this doesn’t only apply to Meeting for Worship. Perhaps your Local Meeting has a regular craft meet-up, where Friends get together in a room and have a natter while they all knit, or crochet, or weave, or embroider. There’s no reason that can’t happen over videoconferencing – indeed, there are fewer difficulties with using videoconferencing for that than there are for a large Meeting for Worship for Business!
The difficulties that I – and others – have faced in the current pandemic should also be a prompt for us to reconsider how we do various things. I don’t just mean mental health problems, either; there’s also the difficulty that some role-holders will have found simply fulfilling that role under public health restrictions. Is our traditional division of labour optimal? Can we be volunteer-led in a more effective, less hazardous way? We will have to look more widely than my own experience for the full answer, but some thoughts that arise just from me include:
- The tasks of a clerk, especially of a Meeting or of Trustees, aren’t actually all of a piece. They require a lot of skills – for example diplomatic communication, organisation of correspondence, planning and administration, dealing with worldly bureaucracy, and last but by no means least, the ability to lead discernment. I think many Friends would doubt their ability to do the latter, but that ability in combination with the others is a tough ask. More importantly, there’s no inherent reason that all of those things need to be done by one person. Perhaps we should be bold in refactoring roles.
- Any role in which someone is acting largely alone is a huge risk factor. It’s not so much that problems will come up more often – perhaps they will, but that is a less problem than the fact that other people may not know that there are problems, especially if the nature of those problems (or the nature of the person in the role) makes them unlikely to speak up quickly about difficulties.
- Role-based email addresses make it easy for people to check each other’s workflows and take over if necessary. This is made even easier if those email addresses are centrally controlled, which also has advantages for data protection – but that is a topic for another time.
It’s important to realise that we don’t have to go back to business as usual once the pandemic situation is resolved (or as resolved as it’s going to get). This isn’t as much from my own experience as from others’ – some things we’ve done, like increased communication between Meetings for Worship (or other meetings), or Meeting for Worship over Zoom, have enabled some people to participate who struggled before (while also raising more barriers for others). We should find ways to prolong the gains of that. Indeed, if we wished to do so and could find the money, we could enable Zoom participation in our normal Meetings for Worship, even going as far as one terminal in the Meeting Room for each person who wishes to join, so they each have a unique physical location for their telepresence.
My final advice, and more a matter of personal opinion: when you think, or even know, that a person is struggling, and reach out to them, you can’t know that you won’t make things worse. Don’t let that scare you. Reach out, at least let people know you are there, that you hope they are getting help if they need it, and that you’re there to help if you can. If they acknowledge this but don’t lean on you, that’s no insult. If you are still worried, ask if it would be okay if you check in with them every so often, just to make sure they are okay and see if there’s anything they need. Not only does that mean you are there and ready to do things if asked, but it means they have the constant reminder that someone cares.
All our lives are touched by mental health difficulties. It’s said that one in four people have, or will have, significant mental health problems; I think the number can only be that low because of how high we set the bar for ‘significant’. We all experience struggles from time to time, related to stress, events in our own lives, or seemingly at random. It’s how we learn to cope with them – when they happen to oneself or to others – that determines the impact in any final evaluation. By learning, by being compassionate, and by remembering the meaning and value of community, we can help to promote better outcomes for all.
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