Talking about mental health can be difficult and I wrote recently about some of the reasons we may not want to. Part of the problem can be that we lack the words to adequately describe what’s going on for us when we’re struggling. I was reminded of this a few weeks ago when I completed a Mental Health First Aid Refresher course. The training covered several models of mental health and wellbeing, including the mental health continuum and stress container (or stress bucket). Models such as these can never completely describe the personal and often subtle details of what we’re going through, but they can provide a starting point and some common language with which to explore and share our feelings. In this article I’ll cover a number of models I find helpful when talking about mental health, plus two relating to supportive friendships.
The Stress Bucket
Also known as the stress container this model was originally developed in 2002 by Professor Alison Brabban and Dr Douglas Turkington. There’s a useful overview in this article on managing stress published by Lincoln University.
When we’re stressed it’s natural to focus on the events, situations, and triggers that led us into that state. These stressors can be difficult to avoid or eliminate, however, leaving us feeling hopeless or overwhelmed, with no option but struggle through as best we can until — hopefully — things ease up. The stress bucket model reminds us we have other options.
The model invites us to imagine we each have a stress container or bucket. The size of the bucket varies from person to person, and can also vary from time to time throughout our lives. Stressful events and situations flow into the bucket, starting to fill it up. These stressors might include problems with our relationships, friendships, work, or money; anything that adds to our feeling stressed and anxious. If we have a relatively large bucket, it might take a while before it starts to overflow, but no matter how small or large it is, our bucket will fill up unless we do something about it.
The most obvious approach is to address the source of the stress. If we can resolve the issues then the flow of stress into our bucket will reduce or stop altogether. That’s not always possible, though, at least in the short term. And even if we resolve one stressful situation, there’s likely to be another potentially stressful situation not too far behind. It’s possible to become more resilient, which we can think of as increasing the size of our stress bucket. Without being able to let stress out, though, any size bucket will fill up eventually.
We can let stress out in various ways. Think of this as making holes in the bottom of the bucket, or opening taps to let the stress out. Healthy taps include exercise, meditation, journaling, listening to music, or spending quality time with friends; anything that helps you relax, de-stress, and regain a sense of balance. Less helpful strategies include excessive use of alcohol or drugs, or attempting to ignore or avoid the issues. These may provide temporary relief but tend to feed additional stresses back into our bucket.
I like this model because it helps me focus on what I can change, and how I can best manage stressful situations without becoming overwhelmed or resorting to unhealthy coping strategies. I particularly like the taps imagery. It reminds me I can choose which taps I want to open, how much, and for how long. My taps include journaling, blogging, and spending time with friends.
Spoon theory was coined by Christine Miserandino in an article first published in 2003 at But You Don’t Look Sick. The article recounts a conversation with a friend in which Christine shares her experience living with lupus. She passes her friend a handful of teaspoons and explains that each spoon represents one unit of energy which must be relinquished as she goes through her day-to-day activities. The limited — and fixed — number of spoons reflects her need to continuously monitor her resources and manage her activities accordingly.
Although originally devised to explain what it’s like to live with the autoimmune disease lupus, spoon theory has been adopted by people living with a wide range of chronic physical and mental health conditions, characterised by limited resources of energy and focus.
It reminds me that activities that require little advance thought or planning for me, such as cooking a meal or taking a shower, might place major demands on someone who lives with illness or disability. It’s more than simply feeling tired. Someone with few remaining spoons for that day has to mete out their resources with extreme care. They might need to forsake activities or cancel arrangements in order to accomplish tasks that are more important or essential.
Although I wasn’t aware of spoon theory at the time, I recall Fran describing what it was like for her to try and make a sandwich when in the midst of a crushing depressive episode. “Oftentimes,” she said, “I would only get as far as opening a can of tuna and eating it from the can rather than bothering with getting mayonnaise and bread, to save the energy needed to wash the dishes. All energy had to be minutely calculated.”
Sine Curves of Mood, Pain, and Energy
Fran and I describe several models in our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder. One I’ve found especially helpful originated in an interview Fran gave on TV before we met. In conversation with Jennifer Rooks on MPBN, she described the ever-changing nature of her illnesses.
My chronic fatigue syndrome operates like this . . . [Fran draws an up and down sine wave in the air.] My bipolar depression operates like this . . . [She draws a second wave.] And sometimes they go like this . . . [She draws two synchronised waves.] And sometimes they go like this . . . [Fran draws two waves out of phase, so that one peaks while the other bottoms out.] It’s really quite a bizarre experience.
We’d been friends no more than a few weeks when I first watched the interview. Fran’s simple analogy of interwoven waves of pain, fatigue, depression, and mania helped me grasp what it’s like for her to live with multiple, independent yet overlapping, illnesses.
Waves on the Shore
Waves of a different kind feature in the model another friend uses to explore her relationship with depression. As she described for our book:
My analogy is a sunny beach. The sea represents my depression. If I’m in the water out of my depth I’m not feeling so good. If I’m knee deep I am getting better. If I’m walking on the beach with waves lapping at my feet it’s much better. If I’m on the dunes looking back at the sea view at sunset I am happy and content, at peace for a while.
The imagery reminds me of King Canute who demonstrated to his fawning couriers that he had no power over the incoming tide. Like Canute, our friend knows she cannot hold back the tide of depression by willpower alone. Her model nonetheless shows how important it is to take responsibility for what she can influence. She can alter her situation by swimming for shore or stepping onto dry land. In practical terms, this might mean changing aspects of her lifestyle and behaviour, taking prescribed medication, or employing therapies or other coping strategies.
Relentless Army Model of Suicidal Thinking
It can be difficult to convey what we’re going through to someone with no equivalent experience. I’ve never been suicidal but Fran described one aspect of her suicidal ideation in ways that I could understand.
Fran once described these [suicidal] thoughts as a relentless marching army. Each thought must be acknowledged individually, picked up, and set aside before she can take on the next. The assault repeats again and again, sometimes for hours. It is exhausting, and the danger is that weariness and desperation may lead Fran to harm herself, if only to stem the onslaught.
On other occasions she likened her experience to playing the video game Space Invaders, where the goal is to shoot down wave after wave of advancing aliens. It’s a powerful analogy, the difference being that failing to defeat the army of dangerous thoughts could cost Fran far more than a lost game.
Return to Down: My Baseline Mood Model
So far, I’ve described models which help me appreciate what it’s like for other people. What about when I want to talk about how things are for me? I’ve shared a few personal models and analogies here on our blog. One of the most helpful arose from an insight I had about my baseline mood slipping from positive to low.
I’ve always believed my emotional and mental health baseline to be essentially positive and healthy. Things might happen at times to upset my equilibrium, but after a shorter or longer period I return to my place of stability and wholeness. Lately, though, this model has been turned on its head. Instead of events and situations disturbing me from an essentially healthy baseline, it feels as though my baseline itself has shifted downwards. Positive events and situations such as meeting up with a friend, or feedback on one of my blog posts — essentially any of the things I was grateful for last week — can lift me up, lighten my mood, or provide an alternative focus for a while. But, once the distraction has passed, I’m pulled back to this low mood baseline.
There’s a parallel here with the rubber band analogy Fran uses to describe the “rebound crash of pain and fatigue” she experiences with her fibromyalgia if she exercises or exerts herself too much. I’ve yet to fully work through what it means for me, but it helps me navigate some of the (occasional) ups and (more persistent) downs I experience. It’s also helped in describing how I’m feeling to other people.
Two Models of Friendship
Our books and blog focus on mental health and supportive friendships. It’s no surprise, then, that I’m interested in models that relate to personal relationships. I’ll close with two I find helpful when working through issues with friends or exploring my need for connection and support.
In Dissolving the Circle I described my former model of friendship: an inner circle of close friends but almost no one outside of that circle. This served me for many years but led to a situation where I found it difficult to make new friends or handle the loss of people from within the circle. It took time but I eventually managed to dismantle that model and arrive at something much healthier.
In my world now there is no Inner Circle: just me and — everybody else! Of course, some people are closer to me than others, some relationships are stronger than others, but there is no circle, no event horizon. It’s been a revelation. Everything is dynamic, rich, colourful. And I feel free. I am free. I’m free to strike up a conversation one day with someone at the next table to me in a cafe, who seems to be having a rough time. I’m free to chat holiday plans with a couple I bump into most weekends. I’m free to sign up for a course without stressing that I won’t know anyone or whether I will be able to engage. I’m free to meet a new friend for coffee, to enjoy her company and the conversation, and for us to part without needing to know when we will next get together.
I explored supportive friendships in more detail in Spokesfriends and Insular Groups: What Kind of Support Network Do You Have? The distinction is between having a network of people who mostly know one another (one or more insular groups) and having friends who do not know one another well or socialise together (spokesfriends).
If I drew my network out on paper there’d be a dot in the middle representing me, with lines radiating out to each of my supportive friends, like the spokes of a wheel. […] This kind of network is more likely if your friends live far apart, as mine do, although that’s not necessarily the case. A few of my “spokesfriends” have met, in person or online, but none of them know each other well or socialise.
In contrast, Fran has several small groups of friends, most of whom live locally to her. Within each group, people know one another and call or meet up more or less regularly. Fran’s support network could be drawn as a number of overlapping circles, plus me and a couple of others who aren’t in any of her groups of mutual friends.
It’s not a question of one type of network being better than the other, and in practice most people will have a combination of the two types. Exploring the two types of network, though, helps me grasp the different dynamics that can arise within and between friends. It’s a model I’ve used when discussing friendship and support with Fran and other friends.
Over to You
In this article I’ve described a number of models relating to mental health and supportive friendships. Do any of them resonate with you? Which ones and why? What models or analogies have helped you understand your health situation, or that of friends and loved ones? Fran and I would love to hear your thoughts, either in the comments below or via our contact page.
Photo by Lubomirkin at Unsplash.