The Venn Diagram of Mental Health

The symptoms of mental health conditions are often inter-sectional, and overlapping. They are rather general, and often not characteristic of the root cause of the condition. Therefore, it is essential to recognise specific marker symptoms so that correct help can sought early. Guest writer Scarlett Parr-Reid and I discuss these symptoms and our personal experiences of them in this blog post.

Trigger Warning: Some experiences mentioned in this post may be disturbing for certain readers. Please discontinue reading if you find yourself in such a position. Online resources for help and advice are linked at the end of this post.

Ushashi: Lately, I’ve realised how interconnected mental health issues are, especially when it comes to early symptoms. Just like a high fever is one of the earliest symptoms of the onset of any disease and doesn’t really tell you anything about the nature of the disease, some of the initial reactions of the body to anxiety, obsessive-compulsive disorder and panic attacks are also incredibly similar. 

Scarlett: I understand you’ve personally experienced panic disorder and I am wondering what your experience of it has been like. Have you found ways to manage it?

Ushashi: I have been suffering from panic disorder for a while now, and it comes and goes. There have been long periods of time where I was feeling completely fine, but there also have been periods when it got rather awful. I’ve tried several things to address the issue, and as much as there are moments where they’ve worked wonders, sometimes they’re not as useful as I want them to be. 
And to this day, it is a mystery to me, how and why it all began. I’m generally happy with where I am in my life right now, in both professional as well as personal spheres. I have incredibly loving friends and family who are perpetually there for me and vice versa. I am also very meticulous about planning and organising; I have everything under control and duly scheduled almost all of the time. There is no reason for me to panic about anything. But the mind works in funny ways!

The first time I suffered one was in February this year, when someone I was very close to hadn’t replied to me all day! Not a single word, the whole day! So later in the evening, I started to get worried, and I had a panic attack, and since it was my first time, I was mortified and confused and absolutely helpless. It seems silly now, but it’s really the most random things that trigger a panic attack. Turns out he was sleeping the whole day. 

What about you? What has your journey been like? 

Scarlett: I was diagnosed with Generalised Anxiety Disorder (GAD) three years ago. I had been feeling anxious for a while, but it had gradually worsened. I was recommended to take Sertraline, a type of drug called a Selective Serotonin Reuptake Inhibitor (SSRI), an antidepressant that boosts levels of the feel-good chemical serotonin in the brain. What I experienced was this wave of fatigue, like I was carrying this weight on my body making. It really helped to stabilise my mood, which had previously been very erratic, swinging from highs to lows. However, as I was taking it at university, it became clear that it was a hindrance to my academic performance, as I started to lose my concentration. It was like all this extra serotonin had hazed over my brain and thinking was scattered and directionless. This meant doing work was really tough, because I had to try doubly as hard to think straight. I couldn’t tell whether I was just some strange anomalous case study or whether the sertraline was actually causing more problems that it was helping. 
I waited it out for a few more months with no real changes in the fatigue. I started to wonder whether it was worth the side-effects.

Part of my experience of GAD was social anxiety. At best I can describe it as feeling like I was an alien in a room full of humans. They were all getting on and talking merrily and having a fun time. Meanwhile I was wondering if my clothes looked a mess, if I should make more eye contact and if I was saying things that sounded stupid. 

Ushashi: I see so much of my experience in yours, in spite of having been diagnosed with something completely different. That haze, that fatigue you talk about; all too familiar. I’ve also found myself exhibiting obsessive-compulsive behaviours; one example would be constantly locking and unlocking my door. It’s so strange.
Social anxiety is also something I have experienced. It’s this irrational fear of being caught red handed having a panic attack; I don’t want them to see me while I’m vulnerable and confused. And obviously, it’s a really common feeling and everyone suffering from a mental health issue struggles with social anxiety to a certain degree. And it’s the same social anxiety that prevents people from seeking help. So social anxiety is a starting point in the diagnosis, but it’s hardly definitive. 

“At best I can describe it as feeling like I was an alien in a room full of humans.”

Scarlett, on her social anxiety

Scarlett: It sounds like social anxiety is a rather non-specific symptom of many conditions. Perhaps we would be better off looking for markers that really differentiate conditions from each other. Often the differences might be really subtle. 

Ushashi: It’s important to address the subtle differences in the symptoms, and even more important for people to actually know about these differences, and to believe someone when they talk about their symptoms. For instance, one of the prominent symptoms of a panic attack is the tightening of the chest, and this eerie feeling of death. Your body grows cold, top to bottom, and as the temperature drops, you feel like you’re dying. But when you describe it to someone, it all sounds very animated, because how does one know what dying feels like? And the worst part is that your thoughts and symptoms during a panic attack are in this cyclic relationship, where the more you think about how you’re feeling like you’re dying, the more panicky you get. And the more panicky you get, the colder you start feeling. It’s really hard to put a stop to those thoughts and take a deep breath and actively try to calm down. 

What I would also like to remind people is that the very early symptoms of COVID-19 and Panic attacks are surprisingly similar, and it is very easy to tumble down that rabbit hole. You can’t breathe, your chest is tightening, you can’t smell anything, and you think “Do I have COVID? Should I call someone?”, and then you panic about your health, but you’re actually having a panic attack about something else, but you can’t help it. And 2020 hasn’t been easy, so your panic attacks are justified. It takes so much time to recover from that. 

Ushashi: How do you think we can increase awareness of these symptoms? 

Scarlett: I think Improving education on ‘mental health first aid’ will help to increase awareness. Unfortunately, there is very little mental health in the medical curriculum. The more we know about the crossover between mental health conditions and the possible side-effects of medications, the better the decisions we make about our own well-being. For example, we can weigh up whether it is worth taking Sertraline and possibly experiencing fatigue and lack of concentration or trying another treatment. Early intervention is key to better long-term outcomes, which means knowing the markers of mental health conditions. 

For anxiety, the marker symptoms to look out for are a difficulty concentrating and a tendency to catastrophise which gradually mount over time. Whereas panic is a sudden and intense wave that tightens your chest, leaving you feeling like you are going to die. What we’ve seen is that anxiety can lead to panic and panic can lead to anxiety. They are not mutually exclusive. And OCD involves unwanted thoughts and compulsions leading to repetitive behaviours. It’s not simply a need for control, but a sense that there is safety in order. 

Ushashi: You’re quite vocal about mental health, its symptoms and how to ask for help. In all these years, what have you learnt about it?

Scarlett: What I’ve learnt from all this: mental health is a very fragile thing. And the work doesn’t just stop after a course of CBT. Mental health conditions are also very much intertwined. One can feed into another and one can also trigger another. Dealing with them begins with ruthless honesty and disciplined effort which has to happen every single day, not just when you have flare-ups. I remind myself of the Japanese word Kintsugi. Resilience. Cracks filled in with beautiful gold. This is what I try to embody when I approach my mental health. Whilst our mental health happens to us, it is not us. We are not defined by it. 

Ushashi: Yes, I agree. And help is everywhere, really. It’s only a matter of seeking for it. The earlier we recognise these symptoms, the easier it becomes to address them.

Scarlett Parr-Reid has a BSc in Medical Sciences from the University of Exeter and is currently an MSc Science Communication student at Imperial College London. She is passionate about the interrelationship of medical science and mental health. She has been volunteering with the Motor Neurone Disease Association for three years. For more from Scarlett, visit her website or her LinkedIn profile.

We understand that it is often difficult to talk about these things with people we might know, or for the fear of being judged. We have compiled these online resources for anyone to check out, should they in any way resonate with our conversation. Of course, nothing is better than professional help, and we highly recommend reaching out to someone if you experience any of the above mentioned symptoms.

Online Resources:

Silvercloud: an platform with evidence-based programmes and resources on mental health, including journaling for your wellbeing.

Mind Charity: a mental health charity providing support, information and resources on a range of mental health conditions, including helplines and self-care tips.

Nightline Association: an anonymous listening service run by students for students every night from 8pm-8am during term time. This includes phone lines, web chats, Skype and emailing.

Psych2Go: a YouTube channel specialising in mental health and psychology. There are great videos on mental health signs and symptoms.

Headspace: a guided meditation platform, especially useful for those with panic disorder. They have meditations available for all kinds of situations, such as for when one is feeling overwhelmed, or if one is burnt out. There is also music to calm down to. You can also get it for free with a Spotify premium account.