Managing anxiety and depression in relationships
Managing mental health when meeting someone new - the early days of uncertainty and strong emotions.
I have likened the experience of meeting and falling for someone new to juggling. Four years ago I had found equilibrium, all the balls were in the air and I was genuinely happier than I had been for a long time. Suddenly another ball was introduced into the equation. This is a ball which brings with it strong emotions; uncertainty, interdependence and allowing others some element of influence over how I feel. Fitting this ball into the show without dropping all the rest proved difficult.
Getting to know him, particularly those early weeks of texting and emailing endlessly between meeting up for ‘dates’ was very destabilising - it became much harder work to stay on top of things and maintain the high levels of contentment and happiness the few months before had bought. Without my noticing the obsessive, inward focussed, over thinking part of my brain - the overgrown slightly monstrous part that makes me ill - had stirred. It breathed it's negative fog breath over everything and made it harder to gain pleasure from other things.
It felt as if healthy normal emotions associated with falling in love (excitement, uncertainty and perhaps slight obsession) had fed it and encouraged it to rear it's ugly head and distort normal and manageable emotions until they smeared across my whole life. I asked myself, could I risk letting these emotions run their course or is there too much of a risk of disturbing the beast and getting lost? If I feed the monster with real human negative emotions and vulnerability there's a real risk of it taking over until I can't tell what is a real reaction and what is a distorted, depressive reaction unlinked to reality.
But despite becoming irritated and angry with myself for allowing this to happen, it did make me realise something about my struggle with uncertainty. With no real choice but to continue to meet and discover this guy (and hell, am I glad I did), I wondered if perhaps managing something like this - really liking someone and all the risks it brings - was a good test for my newly growing happiness.
Could I keep the vulnerability of a growing liking for someone, coupled with the uncertainty and risk of rejection (and the fact that, should that happen, I would inevitably universalise it and take it as an example of my possible inability to conduct real romantic relationships any more) separate from the obsessive, depressive element of my personality? I wrote a little more about how I worked through some of these emotions in my post ‘Writing my mind –writing in the immediacy of the moment’.
Managing depression and anxiety in a committed relationship
That was the early days. And despite the uncertainties being countered by excitement and the rushes of dopamine and norepinephrine, I'm glad they're over. But how do you manage when depression or anxiety are part of a committed relationship? It isn’t easy. Depression and anxiety can magnify and distort emotions.
You need to be on your guard. When looking through their unnatural lens, you can start to feel that there is a problem with the relationship, or with one party within it. It’s something we get asked about a lot, either to help someone understand their own reactions to relationship issues - or wanting to help and understand others whom they love.
Recently, I have come across this diagram of a 'rollercoaster of change'. I like how it externalises the course most relationships run at some point, and shows how support can help a couple avoid crisis.
A more detailed diagram shows the ongoing post-crisis path at different levels. With the right support a couple can return to the original path. But without it they may come out of crisis level but continue to function at a much lower level, taking very little to send them down to that point of crisis again. When you have to manage mental health in a relationship you need to ensure that that safety net is strong and maintained by you both to avoid regularly hitting crisis.
So what works? Well, in my experience;
Establish it as something external to you both - distinguish between what is you and your relationship and what is the depression or anxiety.
Step back and set yourselves up as a team, dealing with and managing the illness together. Viewing it as external to you both stops it being associated purely with one individual or becoming too intertwined with the rest of the relationship. It's hard to do as it isn't tangibly physically separate in the same way as a difficult family member or awkward landlord - but try to approach dealing with it in the same way. A lot of people say they find a metaphor such as the black dog useful as a way to clearly define the illness as an external party. This brings me nicely on to;
Find your own language to talk about it and use this to help your partner understand.
Personally, when I get very low I get needy and dependent. Because these are more negative experiences one might have in a relationship anyway, it's important to identify that these are a result of the depression or anxiety and not of something else going on. Try and identify how the illness makes you interact differently and explain this. Saying 'when I'm low, I feel really needy, so I might be a bit dependent and irrational today' sets you up much better to manage the day than communication purely based on the current feeling of neediness 'why are you going out today, I really want you to stay in, do you even love me?'. This leads me on to;
Examine your motivations before you act
If you are feeling depressed, a symptom of that might be that you feel needy and dependent. If your partner doesn't realise this is a symptom of your depression they may well feel your behaviour is irrational - and tell you so. You might feel that they don't understand you and respond by ignoring them or going quiet and refusing to open up. But what is your motivation here? Fundamentally, what you might want is for your partner to pay you the attention your 'needy feeling' wants today. But playing these kind of games isn't the most straightforward way to get there. It may well start an argument or cause upset when it doesn't go your way and, for example, they just leave 'because you're ignoring me'. So instead - before you take an action which might affect your relationship - try to establish what it is that you really need and think about whether there is a clearer, more open path to get it.
Use what works even if it feels weird
It's really common to feel as though a relationship should flow along wonderfully and if it doesn't then there is something wrong with it. In fact this is quite a disempowering viewpoint. Relationships take work and management - but this also means you have agency in them. You have the power to make it work if you both want to. Sometimes this involves finding tools and techniques to help.
Some of the suggestions for managing really difficult times in relationships include ones using numbers to help you communicate when you're not feeling up to a long conversation. Deciding what the numbers mean (1 might be 'I'm just about doing ok, but could use some love today so be patient with me' and 5 might be 'I'm really struggling, I don't even feel able to talk about it but I need you with me today so much I need you to prioritise me over other plans') and then using them to communicate how you feel could help when, in the moment, you're not able to put it into words.
Another tactic if you are struggling to put everything you want to say into words is to try writing it down. It might feel odd initially to hand your partner a letter or send them an email when you live in the same house - but you might find that it works. You have more time to formulate what you want to say and they have more time to absorb it and work out how they feel about it. These techniques might not work for you but my point is that you shouldn't feel odd about using whatever does. It's actually a really normal and healthy way to negotiate difficult times effectively.
On a slightly different note - be prepared and open to trying things that you might not think is 'you'. This might be a mindfulness course or some counselling - as a couple or individually. Finding new spaces and ways of managing and talking about how to strengthen your couple 'team' can be really valuable - and in ways you don't always expect.
Enlist the help of your partner in helping you to recognise when you're struggling and reminding you it won't last forever - and don't disregard it when they do.
In a previous blog entry, I wrote about how when you are in the midst of a depressive episode it's hard to imagine that you will ever feel better. You can't remember what it feels like to feel good. You often need help in this state to be reminded about what feeling better feels like. Your partner can help with this. When they do remind you it's very easy to push it aside - that's what depression makes you do. But try and remember to listen to them - even if in the moment you can't genuinely believe what they are saying. Knowing your partner knows you and wants the best for you means it is easier to trust them when they are encouraging you that taking a shower, taking a walk, going for a run or attending your appointment is actually a good move.
Similarly, a partner can help you to notice when you are showing the warning signs of a relapse - especially if you identify what these are and put them up on a list somewhere. I explore this in more depth as part of my series for Mind on MBCT called 'How can I best take care of myself'. Identifying the warning signs is a useful exercise for you both.
Read up on it and ask about it.
Know your enemy. There are loads of useful resources both on and offline which can help you both to understand the issues and how you can help each other. These include factsheets and articles - for example from TheSite, Rethink, Mind, Sane, Couple Connection or magazines like Mental Healthy. If you find something that seems to make sense to you or describes how you feel or the interactions you have as a couple - share it with your partner.
There are also loads of forums and support groups that can help. This leads me on to;
Look for support from others.
As a couple, you will be managing depression or anxiety as part of your relationship. But both partners can benefit from getting external support. I've done some work with Mind on their Elefriends community. In the workshops I attended a number of participants said they either came to the community to ask about how they could support their partner - or they liked the fact that their partner who was struggling had access to support on the Elefriends site during the day when they were alone. Similarly, on TheSite.org, we get lots of people asking about how to manage mental health in a relationship. Hearing other's stories or just having somewhere else to talk about it - whether this is online, or with a friend over coffee or a drink - can really help.
Don't underestimate the pressure that being the one relied on can cause.
This follows neatly on from the previous point and is mainly for a partner who tends to spend more time supporting the other. In many relationships I think this role can be one played by both partners at one time or another. When you are close and open about managing mental health in relationships together, it can be easy to become too reliant on each other. It can feel as though they are the only ones who understand. But being the only one relied on can be a lot of pressure - even if it feels like you can manage it. Think about who else around you can also help to support you or your partner (maybe friends or family?) and get them involved.
Finally, and most importantly, keep talking. For me, open and honest communication - however it works for you - really is key.
So that's my thoughts. What works for you?