On Mental Hygiene

Hey y’all: I wrote a blog for Mental Health Colorado late last month. If you’d like to read it you can find it and other mental health stories here

At my last NAMI Family-to-Family Class talk, my good friend asked me a very interesting question: what do I do to maintain my mental hygiene?

I don’t feel as though I sufficiently answered that question in the question and answer session after the talk. It’s a difficult question to answer because there’s a lot of stuff that I do to maintain my mental hygiene. I suppose one could argue that my entire day centers around taking care of my mental hygiene. From the time I wake up until I go to bed at night, it’s a constant process of assessing my current mental state and adjusting what I’m doing according to how I’m feeling and what I think I need to do to possibly feel better.

And that’s exactly how I define mental hygiene: the daily process and rituals of maintaining good mental health.

Just like we brush our teeth, wash our hands, bathe ourselves, put on clean clothes, and all the rest of the daily routines we have for maintaining physical hygiene, mental hygiene must be maintained daily. And it’s important for everyone, not just those with mental illness, to practice it.

I remember sitting on my stoop with my neighbor a few weeks ago, smoking cigarettes and talking about problems. I’d just told him about how I have schizoaffective disorder and he was wondering how I managed to appear/act/be so normal in the face of something he assumed you’d have to be in a mental hospital for the rest of your life for.

I told him: I exorcise my demons with routine.

And that’s very much true. My daily routine is incredibly important. Whether it’s taking pills at 9:00a and 9:00p every day, my mandatory smoke break every two hours, regardless of what I’m doing; my scheduled work time in the morning, or my weekly hangout times with my friends, my life is very structured; all according to a routine I believe helps my mental health.

Everyone’s routine is going to be different – the various needs we have as human beings on planet earth makes it impractical to exactly duplicate my routine. I’ve found that I have to keep my routine somewhat flexible – so that I don’t get stuck in a mode of thinking that it’s 10:30a so I must be writing, when what I really need to be doing is sitting in my chair and listening to music. The routine is more of a guide that lets me know what I ought to be doing at any given time of day; a guide that can be deviated from if I need to. The one exception is pill time. When the alarm on my phone goes off to inform me it’s time to take a dose of medicine, I stop what I’m doing and take it.

My bedtime routine is the next most stringent – every night, after I take my pills, I roll a cigarette, smoke it outside on the stoop; and, when I get back inside, I clean my kitchen, put Kerrin’s dog toys away, and get ready for bed. Always in the same order, always in the same way. I set my clothes out for the next day because otherwise I’m likely to just wear the exact same thing the next day. I get into bed and I read until about 10:30p and then go to sleep.

The lack of variance in my bedtime routine, I think, prepares me better for sleep. It lets my brain and body know to get into sleep mode. Sleep is crucial for someone like me, particularly given that I have bipolar disorder as part of my diagnosis. My brain wants to stay awake at night, my brain is naturally more alert at night. So to have a bedtime routine that lasts 30-45 minutes gives it plenty of time to change gears.

I’ve sometimes thought to myself that, since I don’t have anywhere to go in the morning, I don’t really need to get to bed at a decent time. Why don’t I just treat myself like a grave yard shift worker and sleep during the day and work at night? I’ve thought sometimes that my writing would be better because my brain is naturally more alert – I wouldn’t have to depend on Dexedrine to get myself up in the morning.

My psychiatrist disagrees with this. He’s told me time and time again that having a normal circadian rhythm is crucial to the mental health of someone with a mood disorder like bipolar disorder. And beyond that, there are the practical aspects: it’s good for me to be exposed to daylight. Daylight is cheering. It produces Vitamin D which helps fight depression. Daytime is also when everyone else is up, if I want to go to the coffee shop next door I’d best be up during the day because it closes at 7:00p. If I want to go to the local book store or record shop, I’d best be up during the day because they’re not open at 2:30a. Everyone else I know is also sleeping during that time, so I’d never be able to see them if I were to reverse my sleep schedule.

There’s also something of a morale boost in being up with the rest of the world. I remember when I first moved out of my parents’ house, I was having to get 14-16 hours of sleep a night. It didn’t matter if I went to bed at a decent time, I wasn’t getting up at a decent time. And so I felt like an other, like a pariah for getting up after everyone else had already been up for hours – at their jobs, doing productive things. That being said, it’s also important for me to get as much sleep as I need. I have a fairly consistent sleep schedule. But there’s still that one night every week or so when I need to get 12-13 hours of sleep. This is where attitude comes in.

I remember my parents’ sometimes telling me and my sister when we were younger to have a better attitude. For me, it was usually in the context of being forced to go on a family outing when all I wanted to do was stay at home and play video games. I learned a valuable lesson from those times, though. Namely, that I am in control of my attitude. I find it difficult to try to explain how one goes about actually changing their attitude, but I have a visual I like to keep in mind which helps me.

Taoism talks about being like a reed in a river. The successful reed, the reed that survives, is the reed that bends with the current. The reed that’s rigid is the reed that snaps when the current gets too strong. If you’re too rigid, if your attitude isn’t one that can adapt to sudden, seemingly random changes, you’ll break apart. I remember this most when I wake up in the morning only to look at my bedside clock and realize that I’ve just slept for twelve hours. It used to get to me, because I’d just slept away most of my writing time for the morning. Now I try to tell myself that I was just getting the sleep that I need and if I want to, I can work in the afternoon.

Routine needs to be adaptable to sudden changes in needs – it can’t be this rigid structure which doesn’t allow for random events to happen. My life is full of random events. I might fully expect to go someplace in the evening only to have a psychotic episode in the afternoon and have to make the decision to stay home instead to take care of my brain. I might expect myself to write for three or four hours in the morning only to get to my computer and realize that I just don’t have the brain power. I know from long experience that I can do certain things to try to get myself in gear, but past a certain point it’s better to just rest and not try to force myself to write because that writing isn’t going to be any good and the process of writing it isn’t going to be any fun, and indeed, might even be damaging to me.

There’s another key aspect to my mental hygiene: my Hobonichi. I’ve written before about my Hobonichi, a Japanese style planner in which I keep a daily log of how I’m feeling and what I’ve been up to. It’s basically an attempt to amass data about how well I’m doing in order to best know how to treat myself.

Thanks to my Hobonichi I’m better able to notice when I’m manic or depressed, I’ve been able to predict when psychosis might occur, and I’ve been able to provide my psychiatrist and therapist with invaluable data about how I’m doing.

I mostly do it because my memory is so poor. One of the hardest questions someone can ask me is “what have you been up to?” followed closely by “how are you doing?” and those are the two main questions psychiatrists and therapists are concerned with. Every week, before I’ve even sat down, my therapist always asks me how I’m doing and I’m glad I’ve taken my Hobonichi along with me and studied it so I have a better answer.

I feel as though, if I didn’t have it, I would be wasting an appointment either trying to remember what I’ve been up to or how I’m doing or else talking about something that wasn’t even important at all. I get an hour with my therapist once a week, and that’s not always enough time to talk about whatever it is I need to talk about, so it’s important not to waste time.

Having data in general, is useful. It would be difficult for me to know what might trigger me if I didn’t have my Hobonichi and seen that every time X happens Y symptom usually results. It doesn’t have to be a Hobonichi (though I highly recommend one), a simple notebook or Word document on your computer will suffice. But having data goes a long way toward helping your doctor(s) treat you more effectively as well as giving you sense of how well you’re doing compared to this time last week/month/year/whenever.

The last thing I think is crucial for my mental health is those things I avoid. Alcohol and drugs top the list. I’ve never really gone over the top with alcohol but I eliminated it completed ever since I got on Latuda and had a really bad emotional reaction to half a glass of beer. With drugs, I only take those prescribed to me by doctors – I figure the concoction of drugs my psychiatrist has me on is enough and I’d never know how a strain of marijuana will effect me because of the medication I’m on. My psychiatrist supports this opinion – too little research has been done on marijuana to know how it would affect my brain. The chemistry of the brain is a fragile thing and so I limit myself to caffeine and nicotine, both of which seem to help me.

Most people, when they know about my mental illness, totally understand why I wouldn’t smoke marijuana or drink alcohol – there seems to be a sort of innate understanding that it’s inherently bad to consume such things when you have schizoaffective disorder. What people have a hard time with is me not watching TV or movies whatsoever. I have acquaintances, who know about my mental illness, who are always suggesting I go see a movie despite my having told them (numerous times) that movies and TV are just bad for me.

I’ve written before on the effects of movies and TV – how The Land Before Time left me so distraught as a child my mom wouldn’t let me watch it ever again, how I welled up in tears at a Superman movie when he learned how to fly and flew into orbit – it was just the music that did it, in combination with the emotional impact of someone discovering something about themselves. When I was watching Game of Thrones and The Walking Dead, I started living in a delusional world where I thought threats could come from anywhere, that life was much more dangerous than it actually is, and so I started carrying around a six-inch, Marine-issued Ka-Bar knife with me. I would have strapped a great sword to my back if I could have, complete with chain mail and plate armor … luckily I couldn’t afford such things.

Movies and TV destabilize me, they take me out of reality, they mess with my emotional register. And it makes sense, movies and TV are specifically designed to manipulate your emotions. But beyond just manipulating my emotions, they can also alter my sense of reality. Years ago, while still recovering from ECT, my dad and I sat down to watch a Bill Cosby comedy routine on DVD. We figured that since it was a depiction of a recorded event that actually happened and that it would just be shots of Cosby on stage and the audience that it wouldn’t be a problem. Shortly into the video, I blinked and suddenly Bill Cosby was standing in my living room. It was like he’d jumped out of the TV, right in front of my chair. He looked just as real as my dad did sitting on the couch next to me. I told my dad and he switched off the video and I gave up watching any kind of movies or TV for a while.

It was hard for me to give up movies and TV. As my sister wrote in her blog in January, watching movies was something my family and I did together often. I’ve always enjoyed them and dabbled around with making movies of my own when I was in high school, even applying to NYU’s film school when I was a senior. For a while I watched pre-recorded football games and that was my sole outlet for watching TV. I’ve never been much of a football fan, but the blue-collar ballet performance of it fascinates me. I figured that since I didn’t have any emotional connection with the game and that it was so benign, I could handle it. But, in tracking my mental health on my Hobonichi I noticed a trend of decreased health on days I watched football games as a way to wind down.

I use music and reading as my primary way of winding down now. Or else I listen to lectures or podcasts on my stereo. I don’t own a TV anymore, I gave mine away to my parents. And people are kind of weirded out by it, I remember someone coming over to my apartment and noticing that I didn’t have a TV and reasoning, almost desperately, that I could just turn my iMac around to face the couch in order to watch something.

The things I don’t do are nearly as important as the thing I do do. Mental hygiene is something that must be practiced every day, just like we brush our teeth and wash our face every day; just like we bathe regularly and put cleans clothes on – it’s important to attend to the maintenance of our mental health on a regular basis. It’s important even if you don’t have a mental illness.

In choosing things for my mental hygiene, I seek people, places, things, and activities that are grounding. I don’t think of grounding necessarily in terms of figuratively being on the ground (as opposed to in the sky), but in terms of an electrical circuit. When you ground an electrical circuit you’re protecting it from the very thing which gives the circuit life – the electrical current. Without the grounding, the electrical circuit is dangerous. In many ways, my mental illness is the source of my creativity, in many ways I have my mental illness to thank for the wonderful life I now lead – for the excellent family and friends I get to enjoy. But mental illness is also dangerous. If I don’t ground myself, I can find myself damaged by the sudden raptures of my own head.

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