Self-Care : Managing Mental Health

 I am not a therapist or doctor. This section is about basic common sense wellbeing and my experiences of working to maintain mental health with a chronic mental illness.

This post goes hand in hand with the one on managing physical health. Your brain is an organ that needs proper nutrition, rest, and care. If you don't have the basic physical needs met, its going to be harder to address your mental health.

Managing mental health is going to look different for everyone. It will depend on your constellation of symptoms, your diagnosis, and your goals. There are many tools available but what works for you might now work for someone else.

There are some forms of managing mental health that are more common than others. Often these are done as a combination but may be done exclusively.

• Therapy
• There are MANY types of therapy such as DBT, CBT, EMDR, etc. The type that works best for you will depend on your particular diagnosis and goals.
• Meditation/Mindfulness
• This can be used in conjunction with therapy and medication or alone. 
• Medication
• Some people find medication to be extremely helpful while others do not. 
• Progress is often not linear with medication and working closely with a doctor is necessary.
• WARNING: Self medicating with alcohol and/or recreational drugs may create long term issues such as addiction. 

How you manage your mental health is entirely up to you, but it is your responsibility to be informed and advocate for yourself. Learning as much as you can about your diagnosis, the treatments available, and the possible outcomes will allow you to set obtainable goals and work toward them.

Some good places to start are below:

https://www.nami.org/about-mental-illness/mental-health-conditions/

https://www.psychiatry.org/patients-families/what-is-mental-illness

https://www.who.int/news-room/fact-sheets/detail/mental-disorders

https://www.nhs.uk/mental-health/conditions/

https://www.mentalhealth.org.uk/explore-mental-health

Ready to look for a therapist, but don't know how - Check out this article that explains how:

How to Find a Therapist

Recently there has been an explosion of therapy apps like Better Health or Grow Therapy, if you are using these please be sure to thoroughly vet the professional you are working with. Depending on where you live and your insurance, these services also may be more expensive than traditional therapy.

Many traditional therapists are now offering telemedicine as part of their practice so you may find you have more options available to you than you initially thought.

Can't afford therapy but want to work on some topics on your own? Try these websites with free therapy workbooks.

Free CBT workbook

Free Therapy Workbooks

*** My Experience ***

I have posted some vlogs on here already about my personal progress with therapy and meds. I will likely do another vlog soon as an update.

I currently manage my mental health using routines, medication, and diet. I work with a psychiatrist that specializes in the places mental health crosses over with women's health due to my PMDD.

I was seeing a therapist for several years but was released from therapy as I had acquired and proven I could use my "tools" to function well. My therapist did advise I would likely need to revisit therapy at points in my life where there was a lot of stress and change. I had appointments leading up to my wedding for instance.

I have tried to meet with a therapist since then that was focused on CBT but did not feel she was meeting me where I was at and am currently looking for a new therapist. I want to find a therapist that has a stronger focus on PTSD and that has a background in EMDR, which is proving a little difficult since I want to keep my medications through my current psychiatrist. 

That's the broad overview but what does day to day look like?

I take my AM meds right when I wake up and sit up. This ensures I don't forget to take them and that they are working by the time I need to leave. One of my meds helps with anxiety that sometimes manifests as agoraphobia.

I eat breakfast with a glass of water every morning. Some mornings I am really on top of it and I have something super nutritious like avocado toast with leeks and mushrooms or bagels and lox. Other days that goal is just to get something in my stomach and I chug a glass of water then grab McDonalds on the way to work. Occasionally I really beat myself up about this. There are obviously healthier choices but I remind myself that the goal is to eat consistently and while high in fat, my McDonalds order is also high in protein that I need for my meds to work the best.

I take breaks at work and use that time to nap, color, or scroll positive media (okay its Pinterest fanfiction... but its not the news)

I keep a drink on my desk. Usually I finish my dalgona coffee and then switch to water. Hydration is good.

I go pee when I have to pee. I worked food service for a decade so this was hard to get in the habit of and its easy to assume this has nothing to do with your mental health but I can tell you, I am much shorter and easier to annoy when I am physically uncomfortable. Physical comfort can be important too.

I eat lunch with my husband or bestie (depending on if I am in office or work from home that day). It is a proper break, away from my desk, where I eat a complete meal. Again, sometimes I am on top of it and we have fancy bentos with a variety of food, or left overs from the night before, and sometimes its fast food. These serves a double purpose of allowing me to disengage from work, to spend time with a loved one and to ensure my body and brain have the fuel for the rest of my day.

I disengage from work when I get home. I allow myself my car ride home to rant to either my grandma or my roommate, then I let it go. My family tries not to overwhelm each other with asks when we get home... time to decompress. Occasionally something "big" happens and we all talk over dinner, but its more to inform the family than to rant.

I eat dinner. One of my PM meds works best when taken after a meal of at least 350kcal. (I thought that was very specific but its in the fine print) This one can be difficult because sometimes the anxiety makes it hard to eat and 350kcals feels like an impossible goal. Usually the only way I reach it is using peanut butter which is very calorie dense.

Dinner in my house is a family affair where we all sit down together to eat and talk. It's honestly something I look forward to and find helps me feel like I have community. Its also a great way to check in with what everyone needs. Sometimes that's a home movie date with my husband after dinner and other times my bestie and I go sit in the hot tub in our complex.

I give myself "me time" each night. This can be to game, read, call my mom, have a bath, watch a show, whatever. Its a space to be "off" for the most part. My hair is a mess and I'm in ratty PJs. My make up may be smudged on my face. Its just a space for me to unwind. There are absolutely stressful days where this is right when I get home and climb under my weighted blanket to just stare at the ceiling for a bit. Its a space to let my nervous system reset.

Bedtime is hardest for me. I struggle with anxiety and sometimes if I have hit a trigger, I am scared to fall asleep because of the nightmares. I take my meds about an hour before I plan to sleep most nights and then get around to cleaning off my make up, maybe some skincare or a shower, comfy PJs and then setting up my bed the way I like. My husband will occasionally spend some time rubbing my back or feet if I am having trouble relaxing.

I'll discuss how I deal with more specific issues like flashbacks, hallucinations, and mental breaks in later sections.

- D.M.

Catching Up in 2025

 

Self-Care : Maintaining Physical Health

I am not a nutritionist or doctor. This section is about basic common sense wellbeing and my experiences of working to maintain physical health with a chronic mental illness.

Maintaining your physical health can be one of the most important parts of your healing journey. That's not to say that is an easy process or that it will come naturally. Often times it will take what can feel like an enormous amount of effort.

Physical health includes 

• Basic hygiene activities (i.e. showering, brushing teeth, brushing hair)
• Eating nutritious food regularly
• Exercising
• A good sleep routine
• Attending to medical needs (i.e. routine physicals, taking medication on time, dental work)

It can feel daunting to try and meet all the criteria, especially if you live in a society that places a lot of emphasis on looking or living a certain way. You may have to shift your view point from focusing on how you "look" to others to how you feel holistically. 

Attending to medical needs may be the most difficult because depending on where you are, there can be social and financial barriers to getting consistent and good care. It can be nearly impossible to overcome these barriers for some as in the US we are seeing social safety nets being ripped away. If you do not have access to medical care, attending to the basic hygiene and physical wellness you can do without those interventions is especially important.

Alternately, you may have an aversion to doctors, hospitals, dentists, needles, etc. that make getting care an extremely stressful or frightening experience. Therapy may help with these issues but if you are in a place where you have the option to research and select your providers, you may find a practice that specializes in helping people overcome these issues. I personally use a dentist that specializes in people with a fear of dentists because I found they actually listen to my concerns and are really good about narrating what is happening. 

*** My Experiences ***

This is certainly an area I struggle with. I do want to be healthy and I understand what steps I need to take to be healthy. Knowing and being able to consistently maintain habits are not the same.

I struggle the most with basic hygiene tasks feeling like a chore even when I know I will feel better after I brush my teeth or shower. It varies depending on my level of depression and anxiety who much effort I have to put into these activities. I did briefly work with a therapist on this but became frustrated that most of her advice seemed to focus on people who do not maintain hygiene rather than someone who is able to maintain it but has feels about it. I do think that is you are at a place where you cannot maintain basic hygiene, that therapy may be a viable choice for you. It just was not working for me where I was at.

Other areas are easier because I made them a lifestyle change like eating nutritious foods. I love food and I love cooking so it was fun to find new interesting recipes that provided nutrient dense meals high in omegas (which are good for brain health). I bought cookbooks that are specifically for mental health and I have cultivated some simple meals I can eat when out or traveling. It does mean that my journey with eating for weight loss has been more complicated. There is no trying fad diets or cutting out entire food groups for me, the work has to be in healthy sustainable portion control and moving more. I did have a doctor recommend trying the F Factor which is a high fiber diet that works with my goals and I have seen modest success when I stick to it.

Like many people, I struggle to get enough exercise now that I have switched to a desk job. I am trying to work in more things I enjoy like dancing and hopefully getting to some yoga classes. When the inspiration strikes to walk or hike, I go with it. 

Sleep has been harder for me since I do have chronic nightmares. I am currently on medication that helps with that. It doesn't make the nightmares happen less, it just makes it where I can sleep again after them - like the nightmares don't fully wake me up anymore. I do get much better sleep than I used to but I also still need longer sleeping hours than my spouse who does not have nightmares. This means I have had to develop a sleeping toolkit if you will. I try to take my meds about an hours before I need to sleep. I have a weighted blanket and stuffed dinos that I sleep with. I have very specific youtube channels that I find calming and watch before bed while I unwind (Studies suggest that watching TV before bed isn't good sleep hygiene, but it helps me avoid anxiety spirals). If I wake up too much or cant sleep, I flip my pillow to the foot of the bed and sleep upside down. 

Last we have attending to medical needs. I am at a place in my life where I have health insurance and the funds to access medical care as needed. The routine aspects of this are ensuring that my medications are refilled in a timely manner and taking them on time. Making regular appointments for check ups and screenings (For those with a cervix, you may want to know that a PAP test is not recommended annually - read more here: https://www.acog.org/womens-health/faqs/cervical-cancer-screening). Seeing a doctor when I become sick rather than waiting until it progresses and getting routine vaccinations for illnesses I am at risk for.    - DMGreisl

Control: How Control factors into Abuse (Trigger Warning: CSA, Suicide, domestic violence)

     There is no doubt that control factors in to abuse. It can take different forms and result in different types of trauma but control is often one of the main tools abusers have at their hard. I know readers who are working through their own trauma probably feel this is incredibly obvious, so this section is more for loved ones than survivors.

    Control can be physical, emotional, financial, sexual, reproductive, or social. It can be exerted in many ways, some more obvious and other more subtle. Abusers will often use this control to ensure their victims behavior or silence. It can be as overt as holding a weapon to their body or as insidious as convincing the victim that they are always being watched. Its common for people who leave abusive situations to be asked why they didn't leave sooner. Control is why. Their abuser had assumed a level of control that is hard to explain to others who haven't lived through the experience.

How do you leave if you have no money? 

Where do you go if you have no support group? 

When do you run if you are never alone? 

How do you stop someone bigger or stronger than you? 

How do you escape your own mind when they have twisted your reality?

What do you do if no one believes you? Or worse, they think you deserve this?

What do you do when its your boss or parents?

    Every survivor will have a personal story and the control their abuser had will vary. Its never as easy as just walking away. The act of walking away can be the most dangerous time in some cases, abusers thrive on the silence of their victims.

    " There are too many examples I could give and so I am going to use my personal one.

What would you do to protect your family? To ensure you had a place to live and food on the table?

Those are the questions I had to grapple with as a child because of my abuser. Adult me can see the lies but as an eight year old I couldn't. I loved my family and I knew we struggled. I didn't want my siblings to go hungry and I didn't want to be homeless. I didnt understand what was happening really, because not all sexual abuse is intrinsically painful.

What would you do?

Or the first person I told who would then tell me I would be all alone if I left him. I was young and naive but I had already had the police dismiss me and I was actively suicidal. It was stay or struggle worse if I was alone. I stayed... until he hit me. I wasn't sure if I would kill myself but I was sure he would kill me if I stayed.

I didn't have control of my home life. I didn't have control of my support group (family) and I didn't feel like I had control of my own narrative." - D

Control: Maintaining a healthy level of control

    Its not enough to regain control, it has to be maintained to find security and safety. 

 How to regain control as a survivor can be just as varied as the initial source of trauma. There are healthy types of control such as:

• Taking ownership of the narrative, telling your story out loud
• Establishing boundaries in existing relationships
• Creating distance or going no contact with abusers
• Self actualizing and self work
• Starting over fresh
• Therapy (multiple types)
• Exposure Therapy
• EMDR

    Maintaining this level of control will take consistent, imperfect actions until a habit is formed and likely routine maintenance after that. Ultimately self actualization and working on boundaries is necessary.

    Self actualization is the process by which an individual reaches their full potential. There are multiple stages to this process based on Maslow's hierarchy of needs. It starts with physiological needs, moves up to safety needs, then loving and belong, then esteem, and finally self actualization.

    Some of the simple ones such as air, water, food, shelter, sleep, and clothing can present their own challenges depending on the availability of resources or a history of self neglect. Progress is not always linear because you can find love and belonging but struggle with material needs or safety needs. Everyone's journey will vary depending on what resources they have available at the start of the journey.

Ultimately though the journey is about prioritizing your own wellbeing and accepting responsibility for your own needs, accomplishments, and shortcomings.

    Boundaries will also be needed to protect a sense of safety and ensure needs are being met. This can be especially difficult for some and needs practice for most to be effective. It can be hard to speak out and demand the respect your boundary deserves. Additionally boundaries are about what you will tolerate not your control of others.

"I will not allow you to yell at me. I am leaving" versus " You are not allowed to yell at me."

Accepted that other people have free will and will behave badly at times is part of the process. Its not necessarily an enjoyable part of the process but coming to terms with the difference will help build stronger boundaries and a sense of self worth.

Okay, but how do I maintain a healthy level of control?

Start small and work your way up. It will take consistent imperfect practice to make habits and even then you will likely still need to work on some things more than others.

1. Base Needs - Have you gotten enough sleep? Eaten a proper meal? Drank enough water? Took a shower?

  > "At first, you may need to make a checklist to help yourself remember these things or even set timers on your phone. I still use my list when I am having a bad day. Being hungry can really wreck your day." - D.M.

2. Safety Needs - Do you feel safe? If not, how can you create a sense of safety in your daily life?

> "There has been points in my life where this was hiding in my closet for ten minutes to reset. Sometimes I cant sleep and I need to plan out our budget for six months to feel secure. Does it feel crazy sometimes... absolutely... but I am the person who has to live in my head and the peace is worth it." - D.M.

3. Love and Belonging- Have you put effort in to foster a healthy, loving relationship? Do you need to reach out to a support group to begin building community? When was the last time you texted or called that friend who cares about you?

 > " This one can be a struggle when all my energy is sapped. I have saved especially sweet texts from people I love on my phone to help me when I really need it. Its so much easier to reach out just to say I love you then." - D.M.

4. Self Esteem - What does your self talk look like? Have you taken time today to note the things you accomplished or are you only looking at the unending to do list?

    > "I keep a gratitude journal for this purpose. I note one of each- something that made me happy today, something that made me feel accomplished, something I did for self care." - D.M.

We will be covering this more in depth in the next section as well.

Control: Regaining Control as a Survivor

 This next section is about Control which closely relates to the Safety and Security sections.

    Control seems like a very basic concept on the surface. Its simply who has the power to direct behavior or events. Control in practice can be much more nuanced and complex. It can manifest in different ways depending on the people involved or the dynamics at play. Many, if not most, survivors of trauma struggle with feeling like they do not have control or trying to take back a sense of control.

    How to regain control as a survivor can be just as varied as the initial source of trauma. There are healthy types of control such as:

• Taking ownership of the narrative, telling your story out loud
• Establishing boundaries in existing relationships
• Creating distance or going no contact with abusers
• Self actualizing and self work
• Starting over fresh
• Therapy (multiple types)
• Exposure Therapy
• EMDR

There are also unhealthy or maladaptive forms of control that some may attempt to exert such as:

• Authoritative roles in personal relationships
• Codependency
• Toxic feedback loops
• Extreme helicopter parenting
• Self sabotaging
• Lashing out at loved ones
• Destroying personal property
• Rage issues
• Self isolation
• Self harm
• Physical harm such as cutting, burning, etc.
• Putting ones self in dangerous situations
• Addictions and substance abuse
• Disordered eating (a diagnosis on its own that requires specialized treatment)

    It can be very difficult to find a balance between feeling in control and having a healthy level of control. The support available, the information about mental health, and trauma informed care can be major factors and are unfortunately not universally available. Many people stumble on a combination of healthy mechanisms and unhealthy ones as they work through trauma on their own.

    "Its hard to know where to begin because time doesn't always feel linear to me.  Early on, I know that I often felt like I had no control of my own feelings, no control over my life, no say in what happened largely in my home. Some of the first places I felt in control were in self harm. I was in control over how much it hurt, how often it hurt, where it hurt, who saw it, and who knew. 

Later I worked up the courage to tell someone what had happened. I felt so scared and so much guilt. Telling ones story can be incredible in the right setting but it is also a place of vulnerability. It means letting someone in and hoping they don't use it again you.

The first person I explicitly told about my childhood abuse ended up being my next abuser.  It tainted my ability to reach out for help again. I wish I had adults I felt I could trust but I really didn't and unfortunately my religion at the time did not help in that regard. 

For years I would look for control in the moment using the unhealthy mechanisms. It would feel like I was drowning and then for a moment I would lash out and suddenly people saw me and my pain. This contributed to my breakdown in my relationship with J and was ultimately a pattern I did not want to repeat with my now husband.

 It took a dear friend reaching out to be like "You know I am a broken mess but right now you are worse than me. You need help. Please see a therapist." He was right. I made the appointment and started making an effort on learning healthy mechanisms AND putting them in practice consistently.

Healthy coping mechanisms take more work. They are harder because they are something you have to consistently, imperfectly practice until its a habit. It is worth it though because I get to have normal relationships now and I don't feel like I need to hurt myself. I am the closest to consistently happy that I have ever been now."  - D

    Therapy is not the only way to gain healthy coping mechanisms but it can be an enormously helpful tool if it is available to you. There are many self help books, support groups, youtube channels, and blogs dedicated to helping people gain the tools they need.

    "One of the simplest, note simple not easy, things you can do to start this journey is paying attention to your self talk. How do you talk to yourself in your head or when you are alone? Would you let someone speak to a friend or loved one the same way? Probably not.

You have value. You have worth. You deserve to be happy. You are good enough as you are and your best should be measured against where you started not against someone else's successes.

Being kind to yourself sounds so simple but its a hard habit to engrain. However, once you stop being your own worst critic, it becomes easier to accept when others say something kind to you. 

That being said, self actualization is the next step and being honest, but kind, about your own flaws and shortcomings can be even more difficult. I can be this super kind, hardworking, generous person but I can also be a selfish bitch at times. I am both and that is okay because in the future I can make the choice which version of me I am going to act on. It also means owning up to what I did when I was selfish... and its turns out sometimes my selfish was just a boundary others didn't care for." - D

For Loved Ones

How can you help your loved one feel like they have control?

Consistency, Kindness, and Patience. 

Consistently give them space to express emotions, fears, and experiences. Respond with empathy and never use trauma against them or as leverage in a disagreement.

Be kind and patient. It can take months or even years for someone with severe trauma to come to fully trust that you are a safe place. It isn't personal and you are not being "punished" for someone else's behavior, its about survival and over time trauma literally rewires the brain. It takes time to undo that.

If you are not in a place to provide a consistent safe place over an extended period of time then you need to have a talk with your loved one to set expectations and maybe create a system that allows you both to tap out as needed.

"I know that saying to someone "I love you but I don't think I can deal with your mental illness" has to be a scary moment. My husband said this to me early in our time together and while it did sting to hear, I appreciated his honesty because it let me set my expectations. Over the years he put in the effort to learn more about my mental health, what I actually needed from a partner, and to work on his own issues. In the end, he is an excellent partner to me and handles my mental illness well but we both needed time to work on ourselves to reach this place." - D

Safety and Security: Therapy & Self Help

 This section on safety and security is intended to discuss the ways in which survivors can regain a sense of security after losing their sense of safety. It can be useful for survivors and their loved ones. Each person will have a unique experience as they seek to regain a sense of security, simply because the loss of security is incredibly personal.

In the previous posts on safety and security, we have gone over the ways you can feel unsafe and what way security can be regained. This post is about the emotional and mental tools one can gain to move past the fear and build security.

There are many types of therapy available and personal work one can do to help move past trauma. Research is being done on a variety of new therapies that use various substances to aid in therapy such as ketamine and mushrooms. The exact combination of therapy and perhaps medication that works for one person may not work as well for another. It can be a journey. (I talk about my own journey with medication in the Vlog: A Chat About Med Changes” - DM)

The most common therapy that people with severe anxiety or hypervigilance seem to get is called Cognitive Behavioral Therapy which focuses on thought patterns and building in tools to cope with those patterns or problems. This is different from therapy to process trauma which may utilize EMDR. 

“I found a therapist who was an excellent fit for me and my particular constellation of symptoms to work with when I finally gave in to needing therapy. The goal was always to add more tools to my personal toolbox so I could move through my emotions to be functional.

One of the biggest tools was learning to step back from my emotions and work on rationalizing out my anxiety and fears. There are days it works better and days it doesn’t work very well, but keeping perspective that my feelings are valid but not necessarily a true reflection of reality is important. We have a saying in our house - Your mental illness is lying to you. 

It helps to remember this when I am feeling particularly scared, whether its of myself or the world around me. When my brain says “You aren’t safe.” I have to reply “Why not? Explain it to me.” and more often than not we get into clearly irrational levels of unlikely scenarios.

There are risks to leaving home but the odds of those risks are low. I am far more likely to get in a car accident than attacked by a strange man while looking at strawberries in the grocery store. That being said, the realistic risk that each person faces depends on their location and society, but the ability to rationalize what is a realistic risk and what is not helps me decide if my mental illness is lying to me. 

And if I am being lied to it. It makes me want to prove the liar wrong. Spite gets me through what stubbornness has not. Sometimes that means telling my agoraphobia to fuck off because I want to see my friend and sometimes that means just getting out of bed to shower. Because you know what… ptsd likes to tell me I am not worth it and that I'm failing but I am worth it and I am not failing. My level of success is not measured by what others can do but by how far I have grown on my own journey. I am here. I am alive longer than I though I would be. And most days… I am HAPPY with my life. 

My mental illness is a liar but I can use my rationality to help me move past those lies and that is the greatest tool I gained from my self work and therapy. The ability to rationalize the fear and make decisions based outside emotion.

Well that, and working past my fear of medication. ”  - DM

Therapy can be a great way to learn new tools but it is not the only option. Therapy can be difficult for some to access for any number of reasons. There are some excellent self help resources if you want to start on this journey.

Some of the most amazing resources allow you to access workbooks, toolkits, and guides designed for mental health for free online. Mindremakeproject.org and  Mentalhealthathome.org both maintain lists of free therapy workbooks that can be accessed online. It may take a little time to look through their lists to find the resource that is most applicable to you.

“Technology can be an amazing tool for self help as well. I use the Calm Harm app when I am struggling with self harm ideation and an EMDR app when I need help calming down. There are also mood trackers to help you spot patterns and build healthier habits. 

I do still advocate for therapy but the work you do on yourself and by yourself can be just as important to your healing journey. - DM”