Self-care or self-spare

I realised last week that I might need to take a bit of time off work. I’m not very ill – I wouldn’t be writing this if I were – but neither am I completely well, if well is as good as it gets, or ought to get. I have had a diagnosis of a mood disorder for decades now, and have had a fair number of serious episodes. It occurred to me recently that when I am well I promise myself that I will take time off work early if I need it, to minimise the possibility of a relapse, but that putting it into practice is not always straightforward.

I think it is reasonable, though, and it’s what I would advise any of my patients to do, so why is it so hard? I seem to be caught up in some sort of cultural guilt trip that tells me that unless I am ill to the point of total malfunction, I should carry on – probably with a smile, and certainly without complaining. I don’t think I have ever found it easy to say that I am ill; even in childhood, I remember watching my classmates do so, and wondering what it meant. On the rare occasion when I did so myself, I felt a fake, even then. My parents were of the post war generation, who perhaps lacked sympathy for minor illness. Over the years I have concluded that my mother talks a lot about physical symptoms, whereas my father seems to experience a high degree of health anxiety. Somehow I could never fit the two together in a useful way. I find it hard to tell how I feel, and whether staying off work is helpful.

But it’s not just my family, odd as they may be. I think that staying off work is hard for many, possibly made easier by the pandemic, but even now people will be criticised for taking more time off than others. Yet people are all different – some, through no fault of their own, have physical frailties, some, like me, have mental illness. The problem for me is that it doesn’t show up in a very helpful fashion early on. The main warning sign that I have managed to identify is irritability, and that can preface high mood, low mood, or anywhere in between. I wouldn’t say it garners an awful lot of sympathy, and the other difficulty is that it can be a normal response to a stressful situation. I think most people would agree that stressful situations can trigger relapse in mood disorders, so it’s not hard to see that it can all get quite confusing.

Sometimes you just need someone to tell you what to do – though, being rather contrary, I’m not sure how that would work for me. I think perhaps what I need more is validation, others saying that this is the right thing to do. My husband says so, but he’d probably say that whatever absurdity I suggested, and I don’t think he’s impartial. He’s also been here when I have been very ill, and might prefer that I spent most of my time off work if that was going to help prevent that happening again. So essentially I have to make the decision, whether too soon or too late I never usually know. I spoke on the phone today for a couple of minutes to a very nice GP, whom I’d never met, and she suggested time off, which I knew she would, as there wasn’t anything else to suggest. I’m glad she suggested it, not me, but I don’t really know what to do with it, or whether it will help.

My plan is to indulge in some self-care – my problem is that I don’t really know what that should involve. It seems to be more about not doing things – no sleeping in, no chocolate, no alcohol, less reading and writing – and I’m already getting anxious about what I should do. I have two dogs, so taking them for a morning walk seems a good plan, but what then? What is this self-care that we hear so much about?

And this makes me wonder what it is about work that has led me to take time off to self-care, if indeed that is what I am doing. I have always liked my work, and found it interesting and varied, and I am lucky enough to be part time. But it can weigh heavy at times, for many reasons. For me, lack of perceived resource to improve things for patients is perhaps hardest, but lack of peer support, more so since the pandemic, is hot on its heels. And this is why I sometimes wonder if it’s more an issue of sparing the self, rather than caring for it. Don’t get me wrong, more self-care, and care for others, needs to happen at work, but that shouldn’t, on its own, be a reason for time off.

The need to spare oneself, either due to stress and its many health consequences, or due to the risk of relapse to mental illness, is concerning, and may imply a potential lack of support in the workplace. This doesn’t mean that one shouldn’t take time off – on the contrary, it may be the only way to remove oneself and achieve a better outcome. But there should be thought about why this is necessary, validation that it is necessary, and more thought given to the return to work, and how things can be different.

I hope a few weeks of self-sparing and self-caring, if I can work out how to do it, will reinvigorate me, and reduce the chances of illness, something which terrifies me. Misquoting the great poet Stevie Smith, I hope I will soon be ‘waving, not drowning’.