2.1 Recognising the Signs of a Developing Mental Health Problem
Mental ill-health rarely arrives all of a sudden, in one go, from nowhere. It is characteristically something that develops over time, and, although the exact causes may not always be entirely clear, the central thing to look out for is change — in thought, feeling and behaviour.
In addition to the stress response explained in Module 1, various other factors, such as genetics, family conditioning, life events and circumstances, chemical imbalances in the brain and many others, can all influence mental health.
Signs that a mental health problem is developing or present often include shifts in eating and sleeping patterns, problems completing tasks or feeling overwhelmed by things that didn't previously phase you. There may also be unexplained physical sensations or discomfort, social withdrawal, a difficulty to derive pleasure from activities that you previously enjoyed, experiencing very high, low or variable moods, having strange thoughts or feeling trapped within your own thoughts, unable to relate to other people easily or experiencing hallucinations.
These are just a few signs — whilst there can be a commonality, in reality, everyone experiences mental health differently, and no two individuals will have identical experiences, even in terms of the same conditions. There are many other symptoms that can also reveal mental health problems, including compulsive behaviours and thoughts, addictive behaviours, reckless or risk-taking behaviours and suicidal ideations.
Aside from suicidal thoughts, which must always be attended to, by seeking help and support, experiencing only one change or shift may not be cause for alarm, as it's common to experience changes during times of stress or transition. The key things to note are if multiple changes are happening, or if any particular change bothers or distresses you consistently for two weeks or more. If you have noticed this in yourself, or another person, it's a good idea to talk to someone, such as a friend, colleague or professional, in the case of yourself, or talk to the person about whom you are concerned, to check in with them to see how they are doing.
There is a wealth of information online, which can sometimes be overwhelming, but we make several suggestions in Module 3, to help you navigate where to look for targeted advice. For now, we will focus on depression and anxiety as case studies for how you might notice and respond to either your own or someone else's presentation of mental ill-health.
2.2 Depression
Depression is a clinically diagnosable mental illness. It is a major affliction affecting many millions in the modern world. The WHO (World Health Organisation) has said that, by 2030, depression will be 'the leading cause of disease globally' if we do not act now to change things. Despite science now revealing more to us about depression and mental illness than ever before, and people being generally much more open, we still cannot underestimate the extent to which depression is misunderstood and ignored, and this problem is still very much visible in the construction industry, where the macho culture of 'pushing through' mental and physical suffering is still strong.
Although a low mood is a hallmark of depression, depression is simply not the same as 'being in a bad mood', just as having a runny nose is not the same as having COVID-19 or influenza. People suffering from depression simply cannot 'pull themselves together' or 'cheer up', as common parlance has tried to suggest over the years.
There are three diagnosable categorisations of depression: mild, moderate and severe. Mild depression is understood as having some impact on daily life; moderate depression is defined as having a significant impact, and severe is defined as making everyday life more or less impossible.
The NHS categorises the symptoms of depression as follows, grouping them into different criteria, which can feature in all forms of severity, so the measure is more concerned with how great an impact the symptoms are having on your daily life:
Psychological symptoms:
Continuous low mood or sadness
Feeling hopeless and helpless
Having low self-esteem
Feeling tearful
Feeling guilt-ridden
Feeling irritable and intolerant of others
Having no motivation or interest in things
Finding it difficult to make decisions
Not getting any enjoyment out of life
Feeling anxious or worried
Having suicidal thoughts or thoughts about harming yourself
Physical symptoms:
Moving or speaking more slowly than usual
Changes in appetite or weight (usually decreased, but, sometimes, increased, for example, if depression is comorbid with comfort eating, binge eating or food addiction)
Constipation
Unexplained aches and pains
Lack of energy
Low sex drive or loss of libido
Changes to the menstrual cycle
Disturbed sleep — either struggling to fall asleep, waking up very early in the morning or struggling to wake up and wanting to stay in bed all day
Social symptoms:
Avoiding contact with friends and family and taking part in fewer social activities
Neglecting your hobbies and interests
Having difficulties in your home and/or work and/or family life
Depression is a serious condition, and, without treatment, it can have tragic consequences. However, regardless of its severity, it leaves people feeling down and despairing. Living in this state can also provoke anxiety because, instinctively, we know that 'something is wrong', which can be a very stressful reality with which to try to come to terms while feeling ill- equipped to know how to move forward.
The first warning sign of depression is to look out for feeling consistently low for a period of two weeks or more. There can be triggers, such as traumatic or difficult life events, such as death, divorce, changes of circumstances and also biological triggers, such as childbirth, which can trigger postnatal depression.
Statistically, people are more likely to experience depression if there is a history of it in their family, but, very often, there is no clear-cut cause. It is extremely important to talk to someone you trust, as well as a GP or healthcare professional, who can help you to put together a treatment plan. Common treatments for depression include talking therapies, such as CBT (cognitive behavioural therapy), which addresses the structure of our thinking, which, very often, is instrumental, either as a cause or aggravating factor of depression.
Antidepressants may be prescribed, to help regulate chemical balances in the brain, but it's important to discuss with your doctor what feels like the right approach for you, as everyone is different. It is also extremely beneficial to make some lifestyle changes and shifts in habits, such as doing regular exercise and eating a balanced diet. We will explore more of these strategies in Module 4.
It's important to remember that, by following the known treatment pathways for depression, there is a very high recovery rate, and people can often come out stronger, happier and more fulfilled for having overcome their struggles.
2.3 Anxiety
Anxiety is the state that we experience when undergoing a particularly intense stress response, as outlined in Module 1. The hallmarks of anxiety are feeling tense, fearful and afraid, very often about something that you either believe is about to happen or will happen in the future. If you are anxious because of a specific phobia or trigger, or due to having panic attacks, you will probably be aware of the cause of your anxiety.
For example,
Claustrophobia is a fear of confined spaces that triggers intense anxiety. However, it is also very common to experience anxiety, without having a clear understanding of what the specific cause is. Not knowing what causes it can trigger anxiety more strongly because there is a feeling of loss of control, and you may begin to fear that there is no solution. This is why it is so important to speak to someone who can help you to understand what may be causing your anxiety so that you can deconstruct and overcome it. This is very much possible through CBT and other talking therapies.
Anxiety is a psycho-physiological state, born out of our fight or flight response, as explained in Module 1, and, therefore, in that respect, it is a natural mechanism, designed to help us to deal with the threat. However, when anxiety becomes a diagnosable mental health problem, it becomes counterproductive to our functioning and can be actively distressing. Anxiety can be very severe, and, like depression, has its own range of symptoms, which manifest across different categories. While there is a wide variety of diagnosable anxiety conditions, the most commonly diagnosed presentation of anxiety is GAD (generalised anxiety disorder).
The NHS categorises symptoms of GAD as follows:
Psychological symptoms:
Restlessness
A sense of dread
Feeling constantly 'on edge'
Difficulty concentrating
Irritability
People suffering from anxiety can also experience intrusive thoughts, rumination, excessive overthinking or worrying and can also experience distress emotionally, which may manifest itself as feeling scared, threatened, fearful and tearful. The severity of any or all of the psychological and/or physical symptoms of anxiety can be a major cause for social withdrawal, and social anxiety itself very often becomes anxiety about experiencing anxiety in a social context, as well as perhaps pertaining to a pre-existing fear of social scenarios.
Physical symptoms:
Dizziness
Tiredness
Noticeably strong, fast or irregular heartbeat (palpitations).
Muscle aches and tension
Trembling or shaking
Dry mouth
Excessive sweating
Shortness of breath
Stomach ache
Nausea
Headache
Pins and needles
Insomnia
2.4 Anxiety as an Umbrella Term
Anxiety is effectively a family of conditions, within which, there are many specific forms, which can relate to specific triggers .For example, phobias are when a specific experience generates an extreme state of anxiety, but the 'family' also includes conditions defined by the behaviours that people develop as a result of their anxiety, such as OCD (obsessive-compulsive disorder), panic disorder, panic attacks and PTSD (post-traumatic stress disorder).
2.5 Treating Anxiety
AD can be very effectively treated by talking therapies, such as CBT, but it also responds well to supportive lifestyle changes, such as a healthy diet and exercise. Sharing experiences with others and building confidence in activities that stretch the individual's comfort zone can also be hugely helpful.
With proper treatment and support, anxiety can be successfully managed and overcome, even in its most intense manifestations, so there is always hope. This is where creating a culture of expression and information is so vital in helping to shift the experiences and narratives around mental health conditions — they are not defining and not permanent, and tackling them can very often lead to breakthroughs that deliver deeper and greater happiness to people, once they are on the other side of it. This is completely possible within the construction industry and, hence, why it is vital to spread the message.
MODULE SUMMARY
Depression and anxiety are incredibly common mental health problems. They are mostly detectable through noticing changes in thought, feeling and behaviour. Both are serious, life-altering and, in some cases, life-threatening conditions, which require urgent and proper support. Both anxiety and depression can be successfully treated by talking therapies, such as CBT.Building a culture that normalises mental health as non-defining and something that it's possible to overcome is a vital step in the evolution of the construction industry, to meet the needs of modern life.
In Module 3, we will discuss where and how you can seek help.
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