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What it’s like when I have a mental health 'flare-up'

I’ve mentioned before in previous posts that I live with mental health problems and that this isn’t something which is going to ‘go away’ in any hurry. I tend to find that my mental health ebbs and flows from day to day and week to week – much as you might expect from anyone else, to be honest. Although as an established ‘worrier’, it may be the case that I tend to get hooked in to certain thoughts and feelings rather easily and take a bit longer to recover from the hard times than your average Joe or Josephine.

I’m also perfectly capable of making a song and dance about my mental health, particularly when things get really difficult, such as during the significant episodes of depression and anxiety that I’ve experienced in the past (which I wrote about here). If I don’t make a song and dance, they aren’t always that easy for others to detect, except for those who are closest to me. But the rest of the time, I appear to be pretty much fine (albeit a bit brooding) even though, at times I can be experiencing something of a dip. And during the last few weeks I’ve been going through one of these dips – so I thought I’d seize the moment and write about it.

The idea that I’m trying to convey through this is that mental health isn’t all about big dramas, awful episodes of severe depression, anxiety or OCD, but it’s also about something else – something rather more subtle and not nearly as exciting, but bloody frustrating, pervasive and really quite difficult to manage. And for me, it goes something a little like this…

The Prelude

For the last few months I’ve led quite a busy life. Since April, I’ve had quite a long list of things on my plate. This has included:

  • Looking after, and experiencing such a positive reaction for, this blog

  • Working on a range of exciting (and challenging) projects at work

  • A recent office move at work

  • A few weekend breaks in the UK

  • Reading a tonne of books

  • Watching (and having some skin in the game for) the World Cup

  • Drinking a tonne of coffee

By and large these have been positive influences on my life and have been incredibly productive which has been great news. And with my rediscovery of the wonder of coffee in recent months I’ve been riding a bit of a buzz throughout.

What also happened, alongside all of this was a few, more adverse effects:

  • Finding it harder to make time for Katherine

  • Not really doing things around the house

  • Waking up early and feeling ‘switched on’ from the get go

  • Being pretty knackered some weekends

So – the trend is this: I work and play hard, have a lot of fun, then start to experience a bit of fatigue. I have a great talent for masking this or learning to ignore it – pushing through with the excitement of all the things that are going on and living off the buzz of adrenaline when the tank is starting to run dry. What’s more, I can fuel myself further a bit with caffeine, food, new, exciting plans, pressures and ideas and so on.

Are you starting to get the picture yet? The way I visualise it is of a little electric motor, in my brain, whirring away. This motor starts to pick up the pace, pumping out more and more energy, whirring ever faster, faster and faster. Slowly, sparks start to fly, smoke starts to seep out and you can smell that faint ‘electrical burning smell’. Time to switch the motor off, except you can’t find the damn switch…

Tennis: Good to watch, not so relevant to mental health.

The burnout

This is what happened to me a few weeks ago. Katherine and I had my parents staying and Mum and I had a long, but great day at Wimbledon on Monday (something I can highly recommend by the way!). On Tuesday I was on my way to visit a client in London – a pretty easy day delivering a focus group, at the beginning of what will be an unusually quiet couple of weeks at work (for once!).

I had a coffee in the morning, then as I sat on the train on the way in, I started to get this faint feeling that I ‘ought’ to be doing something. “How can I just sit on the train and stare out the window, when there’s so much to do?" was the thought whirring round in my mind. An odd feeling – I’ve been busy for months and no one is asking me to do anything - surely I should cut myself some slack? But no, the adrenaline which was now running things on my behalf was insisting that I needed to be busy, driving, productive.

Fatigue was also really starting to show through. My eyes were stinging a little. It was hard to get out of bed in the morning. Keeping my energy up during the focus group felt like a real slog. And, having been busy for months, I really wanted to cut myself some slack. But I was so in the habit of reacting to things, of picking up the next task, of reaching out for more stimulus or activity to direct my adrenaline at, that it was almost impossible to slow things down in my brain.

By this point, it’s too late. The motor finally lets out a giant bang, something starts to rattle, and the thing packs in. No off-switch required, so it turns out.

The onset of mini-anxiety

Psychologically at this point, all that is happening is me trying to relax but not being able to. The sense of tiredness beds in harder, I find that it’s hard to be around company and the last thing I want to do is cook dinner when I get home. But I’ve made commitments, I feel like I have obligations, and I have work to turn up to the next day. And every time, I wonder “What’s going on? Why is this happening?” – purely because I haven’t yet realised what is going on. I’m not even aware at the moment that my ‘motor’ has collapsed in on itself.

A semi-aquatic representation of a depressive flair-up

For the next few days, I start to become pre-occupied with my tiredness. “Where is my energy? Why do I feel so knackered? Why is sleep making no difference? How do I stop my tiredness? When will it go away? I Just. Need. To. Rest.”. This is particularly difficult to deal with when things have gone a bit quiet at work. My psychologist Martin and I have discussed that, at this point the last thing I need to do is shut down entirely – since gentle action and occupation is a good thing to help me recover myself, rather than leaving a void to be filled by anxiety.

This mini-episode of anxiety lasted about 5 days. On Sunday, we all went to a family reunion. I started to feel a lot better catching up with some cousins I hadn’t seen in years and shooting the breeze in a social environment with the World Cup on in the background. But shortly after leaving, the thoughts started to whirr again and I had work tomorrow, too. I start to contemplate making an appointment with Martin for the first time since April.


At this point I’m starting to feel a bit fed up. All this worrying and fretting is not doing me any good and I’m finding myself unable to make it stop. I tried meditation and challenging my thoughts and making room for my thoughts and all the techniques I know how, but I'm still feeling tired and rubbish, and I’m starting to tie myself in a psychological knot. The anxiety itself actually has started to wane, but I’m finding that, in its place, I’m left with a sort of void. I’m not looking forward to the weekend, I’m starting to wonder whether this feeling is going to be around for a long time, I’m not really enjoying company and I’m not feeling motivated at work. I try to keep my mind busy, to keep distracted, but dark, odourless, smoky and ugly thoughts start to pour in through the cracks in my mind. From a behavioural standpoint I start to get really quite needy - regular hugs and reassurances from Katherine help.

The Tuesday after the cracks started to show, I woke up spontaneously before 6. Alarm bells start to ring. “Will I sleep this off tonight? Is my sleep going to get worse? What if I’m falling into depression?” All familiar, and scary thoughts. Doubts emerge. “Am I going to need lots of time off work? Maybe I’m in the wrong job. Will I enjoy our holiday in August? Are Katherine and I really right for each other?”. Some intrusive thoughts like “what would happen if I drove into the oncoming traffic” start to come through the cracks, too. It’s quite unpleasant and I’m thankful I have booked a session with Martin for tomorrow.

The fog lifts

On Wednesday, I start to feel rather a bit better, also buoyed by the incoming meeting with Martin this evening. After a more productive day at work I meet Martin and we talk about what’s happened. He helps me to understand that I have literally ‘burned out’ my emotion regulation system. He explains to me a model around which ‘compassion focused therapy’ is based. This says that we have three emotional regulation systems:

  1. The ‘threat avoidance’ system (our ‘fight or flight’ response) which keeps us going when we perceive threat around us. When we are stressed out, this system is working hard, and I figure it’s what’s been keeping me going for the past few months. The third response, beyond fight or flight, is a ‘shut down’ - and this is what has just happened to me, hence the tiredness and general sense of malaise. I’ve been pushing things too hard and my brain doesn’t want to cope any more. This ‘shut down’ also has a knock-on effect on my other two emotion regulation systems...

  2. The ‘drive’ system which performs two functions. Firstly, it motivates us to pursue things which we have an appetite for – be it food, fun, sex or other things like that. Secondly it rewards us for doing things and provides a sense of satisfaction – so we can appreciate doing things we enjoy. Apparently, the second part is a little more resilient, and if we can get that going again, we can start gearing up the whole system again. But this system, by and large, has also crashed, leading to my lack of appetite for fun and enjoyment.

  3. The ‘affiliation’ system which provides a sense of contentment and happiness from being with people we like and whose company we enjoy. Related to this are things like empathy, care and compassion. When we’ve run out of steam, this system also dries up and we find it hard to enjoy company – another thing which has just been happening to me. But if we can gently start to gear it up again, it can also be helpful.

Relating to his last point, Martin and I talked about how I could start to focus less on my enjoyment of things and more on providing care and compassion for others and as a by-product I might start to feel better and this was a helpful conversation. As it happens, I had started to feel a bit better anyway – but this conversation was exactly the boost I needed and helped me to understand what had just happened and to trust in my ability to recover just fine.

The aftermath

Another week or two further down the line now and actually, in spite of my early 'recovery’ I’ve been still experiencing some wobbly times. It often feels like wading through treacle but it's not too scary - more just frustrating. I probably, having started to feel better, took on too much too quickly again when I hadn’t really recovered just yet. A bit like a footballer going back out for a full 90 minutes just after their hamstring injury stopped being painful.

I’m generally feeling a bit better and more reassured and know that if I give it time, I will start to feel more energetic, motivated and at ease again. But I can’t quite seem to shake the feelings of tiredness and malaise, just yet.


This just about explains in a nutshell what one of these flare-ups is like for me. Nothing dramatic, quite common; an incredible waste of time and energy and a real inconvenience. There was a time when I really didn’t know how to deal with these and it would be a lot more dramatic. Without the right support systems and experience I suspect that this would be much harder to handle.

One of the things I find most difficult and frustrating is just how difficult it is to ‘self-regulate’. I’m still working hard on how I can spot the early warning signs of one of these burnouts. I do think I am better at self-care than I used to be and getting a good night's sleep, keeping some regular habits and not taking on too much can really help. But this is something I’m determined to work on and learn to get better at. Something to talk about with Martin, next week, I guess!

Til next time...

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#Therapy #Stress #anxiety #ClinicalPsychologist #depression #Mentalwellbeing #suicidalthoughts #MentalHealthAwareness

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