It would be daft to think that stress plays no role in mental illness – it is, after all, a normal human reaction in difficult and challenging situations, and I doubt that I’m alone in finding the experience of mental illness really quite stressful. I get stressed when I am ill, and often worry about becoming ill. But I realised recently that the relationship between stress and mental illness – and the assumptions that can easily be made – are rather more complex.
My most recent episode of illness occurred last year. As is usual, it crept up on me over a couple of months, culminating in a rapid downward spiral. During the previous year, I had taken on a managerial role at work – perhaps not quite what I’d planned, but it had been going ok, I think. Was it this that made me ill? I suppose it’s possible, and I believe that stress can trigger episodes of illness; but now I’m not so sure. When I look back over the years, my life has been full of more or less stressful events. I am a slightly driven person, and may take on too much at times, but the point is that it doesn’t seem to always correlate very well with episodes of illness. My alternative suggestion is that mental illness causes me to become stressed, and then I, and others, perceive that external factors triggered the illness.
I realise that this may be total rubbish, and it is, in any case, impossible to prove. But I think that had I become unwell at almost any point in my life, that it would be possible to identify and blame a nasty stressor. I don’t mean that my life is particularly difficult, but it is stressful being a doctor, and more generally being a person.
My husband, who has never had a mood disorder, once told me that when he was at school, he spent several months monitoring his daily moods and charting these with whatever was going on in his life. It was quite detailed, with scores given to events that were seemingly good or bad. He found that there was no connection with his mood. He said that this was quite a relief – that things that ought to make him feel bad had no such effect – and changed his whole approach to life. I have no doubt that there are stressors that would defeat us all, but do the less extreme shifts in life make such a difference?
Or should we think a little about the causes of stress? Are these to blame? That irritating colleague, that annoying email – in fact, these aren’t actually stressful in themselves, but the response to them is. Stress is something we feel, not something that happens to us. Perhaps one is also more likely to become stressed by such things when one’s mood is out of kilter.
Essentially, if you’re feeling depressed, everything causes stress and brings you down. When you’re feeling good (or even slightly hypomanic) the same things glitter. Similarly, if you have bipolar disorder or depression, it may be argued that things which cause stress may exacerbate any mood changes.
So what can we take from this? Should those of us unfortunate enough to have mood disorders lay down our burdens and attempt to live a stress-free life? Should we be warned not to seek a “stressful” job, to strive, to have relationships, not to do all the things that are both hardest and yet best in life?
No, we should not. There may be times when we need to rest, times when we make the decision to lead an easier life – but this is for us to decide, not something to be thrust upon us by those who believe that we cannot handle stress. Conversely, I think lack of stress can sometimes be a problem, not having things to do, or problems to solve. Some may disagree, but an in-patient psychiatric unit almost epitomises this for me – I remember having nothing to do, nowhere to go, and nothing to plan – and this was perhaps one of the worst aspects of those fairly grim experiences. I couldn’t have solved any basic mathematics at that point, I was too depressed; but having all life’s structure and meaning taken away, and no expectations – that was hard. It was stressful, even. I remember arguing once, years ago, that, for me, lack of stress was just as likely to precipitate a relapse as its presence, and I think I still believe this.
Last year, when I was becoming ill, I was advised by a number of people to resign from my managerial role. This was all well-meaning, and I think driven by the belief that many of these posts are difficult and stressful. I resigned from another work role (recently regained) at the same time that wasn’t actually stressful, and definitely had thoughts of divesting myself of the lot. As far as I remember, I didn’t actually attempt this. But my point is that this was not the right time to make any of those decisions. What’s done is done, and it may all be to the good. However I still wish that I had not made those decisions when I did. There is an assumption because people see you unwell and “stressed” that the best thing to do is to remove the stressors. This may be true, at least on a temporary basis, but they are not necessarily the underlying problem.
I have always been someone who has liked to work hard and stretch myself, and I used to think that one day I would have achieved everything that I wanted, and gain true happiness. I don’t know how I missed the fact that travelling hopefully, surrounded by whatever stressors it takes, is actually far preferable. Even if I do have a mood disorder.