Let’s talk about distress

A repost of a blog I wrote for my job.

A week or so back my GP got me to fill out the Depression, Anxiety and Stress Scale (DASS). It is a common instrument used by GP’s and psychologists to get a measure of a person’s level of distress. 

I showed high levels of stress and was severe on the depression scale. BAM!

She was shocked and to be honest I was a little alarmed, having spent the previous 10 minutes cracking jokes with her (humour is a common emotional defence). 

Whilst personally the scores were a little wakeup call for me in terms of my own wellbeing (please don’t worry, I will be fine), I thought they also provided an excellent lead-in to a more frank post on distress.   

And to be honest, I think that is what is needed sometimes. There are plenty of websites and resources that speak about mental health in a very clinical way, but the more resonant content often comes from those who have lived or are living with distress. 

So I thought I’d take a little risk and speak from a slightly different place in terms of wellbeing, a more personal place.  

What’s on the surface of someone is not necessarily what is going on inside 

My GP was surprised with my scores because of a discrepancy between my public face (how I present to others and particularly her) and my private internal world.

We all, to some extent, have this discrepancy. We shift or mould our personas based on where we are, who we are with, what we are doing. This is perfectly normal. 

Generally, we try to project an image of competence and control and ‘being ok’ to others. We might not feel safe expressing our feelings, or not want to make things uncomfortable for others. This changes a bit if we are with people that are very close to us. We may reveal more of ourselves, or the more vulnerable parts of who we are. 

Revealing more of ourselves feels risky and to a certain extent it is. We don’t necessarily know how people will react. There may be surprise or confusion on the part of others, if what you reveal is different from how they see and understand you. You may experience this surprise or confusion as a kind of rejection. 

The implications for all of us is that if or when someone does reveal a bit of themselves, remember that it took courage for them to do so. They did so not necessarily knowing how it would play out, how people would react. They took a chance.    

There is a difference between distress and wellbeing

The DASS measures different types of distress – a measure of how much anxiety, stress or symptoms of depression you are carrying at any point in time. 

Whilst this is certainly a potential metric of wellbeing, it is certainly not the only metric of wellbeing. 

Wellbeing is a broader construct including how you are functioning in different aspects of your life, your degree of social connectedness, your access to critical supports like health and education services, having meaning and purpose, life satisfaction and your ability to deal with setbacks and challenges. 

Put simply it is possible to have wellbeing and distress at the same time. 

Why is this important?

Distress can make us blind to the parts of our life that are working OK. It can lure us away from activities and people that are positive forces in our lives. Distress can lead us to make decisions or choices that start to dissolve important parts of our life, setting us up for more distress in the future. It can lead to self-destructive behaviours.  

The knowledge that wellbeing can be built and maintained, in the face of distress, is a reminder to (as best as possible) keep the important parts of your life ticking over. At some point the distress will change or reduce and when that happens, you don’t want your life to have shrunk to the point that it is really hard to get yourself back in the game.

You can continue to work on your life (maybe at a reduced intensity) whilst in distress.  

Brains can be assholes

This is a fairly simple point, which anyone who has experienced highly self-critical or self-defeating thoughts, feelings and behaviours knows well.

Sometimes our brains tell us horrible shit about ourselves, other people and the world. Relentlessly. 

And the real kicker is when our brains go all ‘who me?’ and start loading you up with additional distress in the form of frustration or embarrassment or anxiety about the way we are thinking!

Brain: ‘you are unlovable’

Brain: ‘why do you keep thinking about being unlovable?’ ‘that is stupid’

Brain: ‘you’re stupid’

Etc

Etc

Now to be clear, brains aren’t always assholes and the actions we take can shift the ways our brains speak to us (therapy, medication, social interactions, diet, sleep, exercise etc), but I think our brains should be called out at times on their less than ideal behaviour. 

You have an internal narrative about your distress that you need to get to know

This is fairly obvious but each person’s emotional pain is different. It is there because of different reasons or collections of reasons. There are some commonalities of course. Emotional pain is associated with loss, grief, failure, doubts about our abilities and our self-worth, being rejected, abused or treated badly. But each individual constructs and experiences their pain in slightly different ways.   

With your pain comes a narrative that you develop about why the pain is there:

‘I thought this person cared about me, but they just took advantage of me’

‘I am never going to fit in with this group’

‘I am not good enough to do……….’

Depending on how long you’ve had the pain, the narrative might be quite complex and bring in elements of the past, present and future. 

You need to get to know this narrative. Why?

If you have accurately described why you are in pain, you have, in that narrative potentially got the solution to that pain, or at least some basic guidance on how to avoid it in the future. If I’m in pain due to multiple betrayals then I might need to work on being a little more cautious in who I trust. 

But it is also possible that your narrative about your pain isn’t quite correct. We know that brains are subject to many different types of biases and distortions in the way they explain the world. It is possible that you’ve made some errors in the way you’ve explained your pain. I don’t mean this as a criticism. I actually mean it as a potential path to some emotional freedom. The discovery that a belief you’ve held is a) not accurate and b) has been responsible for some of your pain is potentially freeing.  

There is definitely still a stigma attached to expressing emotional pain

I am a mental health professional and still agonized over whether to be open about my DASS results in this blog post and use them as a basis for a more frank discussion. 

My brain told me things like ‘everyone expects you to have your shit together‘, ‘you can’t teach about mental health if yours isn’t perfect‘ and ‘you are just attention seeking’. 

But eventually I said ‘fuck it’ it is time to own it. If you’re struggling you don’t have to own it publicly in the same way but you can give yourself permission to open up to someone or in some way. The more of us willing to admit that life can be a chaotic shit show at times, the more all of us can let out a sigh of relief that we no longer have to pretend everything is perfect. 

Expressing emotional pain is not abdicating responsibility to deal with it. I still have to put the things in place in my own life to manage that distress, but it is sad that many still feel unable to name their distress publicly for fear of negative repercussions. 

My hope is that you’ll find that expressing what you are experiencing will meet with a supportive response. 

Distress of many varieties is just part of the overall human experience 

There is nothing really that weird about it. 

Yes, western cultures have medicalised many aspects of distress and called it ‘illness’. This has its upsides. It has helped us learn some cool things about how to modify the human experience of distress – therapy, medications etc.

But it also has downsides. Turning distress into ‘illness’ has contributed to us feeling ashamed of our unpleasant experiences as though they are wrong or pathological. We actually have to embrace them as per my point above.

There are many pathways through distress 

When I studied to be a psychologist, I came to believe that the interventions of psychology (particularly clinical psychology) were the best ways to deal with distress. 

There isn’t any doubt in my mind that such interventions can be powerful (e.g. I believe in the power of different models of psychotherapy) but I know that pathways through distress can include many things:

  • Changes to nutrition
  • Exercise and physical activity
  • Sleep
  • Use of medications
  • Modification of the environment (e.g. work and living spaces)
  • Changes to your social situation
  • Alternative work or study arrangements 
  • Reading and self-education

What ultimately works for you might require some experimentation to discover. It might take a while to understand what is driving your distress before you are in a position to look at changing it. 

No-one has this stuff all worked out and you are not alone

The heading says it all. 

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