Self-care is exhausting. Am I right?

Mental illness is hard. So is staying better.

Joshua Merritt
Jan 17 · 8 min read
Photo by Tim Mossholder on Unsplash

Author’s note: This post is half confessional, half therapy. I am truly overjoyed to be feeling better, and to have learned everything I have about taking better care of my mental health. If you’re reading this and suffering, you can and will get better. I’ve learned that even healing has its hard times, though — and in this post, I thought we could rally around them.

First off, all hail self-care. A bit over two years ago, I was crying in bed all day. I was terrified of everything: of getting out of bed, of staying in bed, of my sofa, of being alone, of being with people, of eating and of not eating. To call it a breakdown would be doing it a disservice: when a car breaks down, it just stops. I did not just stop: I revved up, spun out, and did donuts in reverse (on one wheel, honking the entire time) with both turn signals on simultaneously. My brain and body were misfiring.

Now, though, I’m just a bit scared or sad or anxious sometimes. The wheels are mostly on. When they’re off, it’s just for a quick rebalance and rotation. I don’t research the most painless ways to die.

This healthier me comes at a cost, though. It’s a cost worth paying, mind you, but can we just commiserate for a sec? Self-care is freaking exhausting.

I want to confide a few things in you that I think only you will understand, if you struggle in any way with mental illness. I hope you’ll comment with your own experiences, too — what has been hard about healing, and how do you make it better?

Here’s a by-no-means-comprehensive list of a few things that drain me, and how I handle them:

I think constantly — exhaustively — about my mental state.
Do you? I embrace mindfulness and living in the moment more now, but mindfulness has another dimension for me. It means also thinking about each decision I am making, and what the impact could be on my overall wellbeing.

An example: With bipolar and anxiety, I really need a healthy mix of routine and rest. Every meeting invite I accept, every morning trip to the grocery store, every day trip to the zoo is shrouded in another layer of complexity. What will I eat, and when? Will I have time to rest? If I need some solace and alone time, how will I get it? Should I bring my meds or leave them at home? Have I already done too much this week and it’s better to cancel, so I don’t feel overloaded? What do I need in THIS moment? Should I take this project, or pass?

Here, I just accept. This second level of thinking has served me well. At times, the chatter is a bit excessive, and I work to tone it down. But I didn’t have these skills before. I never asked myself what I needed in the moment: I just pushed through at all costs, which didn’t serve me well. Yes, it’s sometimes tiring — but I plan to keep this new self-awareness around.

I love my meds. I hate my meds.
When you have an infection, you get an antibiotic. When you have a mental illness, you spin a roulette wheel of medication and just start trying things until you land on something that works. Each new med takes 8 weeks to kick in. It’s a sick carnival game that you win by just staying alive for the duration of the experiment.

If you’re lucky enough to land on a combo of meds that works for you, it can be a life changer. I’m on a mix of Viibryd (not covered by my insurance, ouch!) and very low doses of Abilify (for mood stabilization), Klonopin (for anxiety), and Amitriptyline (for sleep).

The whole shebang works quite well, unless I miss a dose. Then, bears chase me in my sleep (like real bears, hunting me, all night). The brain zaps set in. Bad thoughts take over and I spend the day wrestling them, trading the upper hand, until I finally pin them back down and win the match.

I tried the “heal yourself naturally through exercise and supplements and diet” route. I read tons of books, spent a fortune on herbs and vitamins and probiotics and a light therapy lamp that made me feel manic. The entire program didn’t really work out for me, and that made me feel guilty and defeated and broken for a while.

Then I stopped judging myself so harshly, and went back on meds. They work wonderfully, and I think I’m finally (after a couple decades) accepting that I will stay on them in some form for the rest of my life. My biggest fear now is leaving them at home on a trip, or a zombie Armageddon eating Walgreen’s. Because let’s face it: my body is addicted to these things, and withdrawal is gnarly.

I feel bad about my impact on my family
My emotions and actions have a ripple effect, and I know it. There will be a day or two on our spring break vacation where I will need to sit out, stay at the hotel and find my equilibrium again. My wife knows it and understands. I also realize that means she will work harder, have to take care of the kids on her own, and in the very back of her mind, she will worry that I am all alone in a hotel room in an unfamiliar city.

I’ve changed the rules for how I live and operate, and they’ve made me a very different person from who my wife married. They’ve made me a different father, too. Its largely positive: I show up more, and I’m far more stable and grounded. I’ll be on this earth much longer. I know that’s what my family wants, and I take solace in that.

But I’ve never wanted to be a burden, and at times, I know I am. When I feel this way, I remind myself that I deserve to take care of myself — and to be taken care of. You do, too, no matter the cost.

On my hardest days, I try to distract my negative thinking by doing something nice back for my family. I clean up the house, or cook dinner, or do laundry. I pick up small surprises for my wife or kids . I find as many ways as I can to show and tell them that I see them, and that feels good.

I am always afraid the beast will rear it’s ugly head again
Again, I’m way better now at living in the moment. I’ve learned to separate rational from irrational worries. With my therapist, we’ve even worked to take some of the power away from my biggest future fears by walking through them, imagining the worst that could happen and how we would react. It’s liberating, knowing a plan is in place.

These crippling depressions have a history of coming back for me, though. Sometimes it’s a six-year reprieve, sometimes four — but they live inside me, are part of my biochemistry. I won’t lie: it takes a low-grade toll on me, the constant hum of what might become.

When the hum gets too overbearing, I have learned to challenge it head-on. I tell it “you are not now,” and I reorient my thinking around things to be grateful for at the moment. It can take a few hours to catch, though, and to reset my mode of thinking. In the long run, a few hours is nothing — but in the moment, it’s tiring, ya know?

I spend a fortune
Okay, so I’ve never had a fortune. But I did have a small life savings, and it’s gone. It’s something else I feel guilty about: spending our small family nest egg on my healthcare.

Each therapy session (two a month), psychiatrist visit (once a quarter), and trip to the pharmacy (monthly) are very big reminders of two stresses: I have a mental illness, and I have to continue to work *hard* in order to be able to afford to take care of it. Without arguing politics, this is a key reason I believe America needs more healthcare reform: no person should ever have to choose between eating / paying rent and getting mental healthcare treatment.

Every time I pick up my Viibryd pills, the pharmacist looks at the total on the screen, makes a surprised face, and asks me sheepishly before they grab the prescription: “And you ARE aware how much this is going to cost, right?”

Yes, I’m all too aware. I’m insured, but not well — isn’t that the nature of insurance these days? For me, Viibryd works best. It’s also over $150 dollars a month, AFTER a big discount from the pharmaceutical company.

I’ll spare you the boring penny-by-penny analysis of just how much this costs every month. I’m lucky that, for now, I can *sort of almost barely* afford to pay for it.

Let’s leave it at this: Money adds another dimension to healing that, in a more moral world, simply wouldn’t exist. To stay positive, I keep doing my part to fight for a more compassionate healthcare system, and sharing my own story with people who might not have an intimate connection to mental illness — so they can become advocates, too.

I have to carefully meter my creativity
I cover this more extensively in my article “18 tips for living a less bipolar life — whether you’re bipolar or not.” Creativity is my life. I write for a living, I write for pleasure, and I am a hobbyist musician, designer, and maker of things. In short, my creativity is the thing I value the most about myself.

It’s also one of the most rewarding — and dangerous — of my personality traits. I can easily get caught up in it, stay up most of the night, and neglect my sleep hygiene in the process. These creative highs lead to depressive lows.

And that’s hard. Who doesn’t want to lose themselves in something rewarding?

I can honestly say: me. I’ve learned that I’m more creative now than ever before. Doing a little bit every day is yielding better results for me than doing a lot, and suffering the downfall. I’m grateful for this realization — but it takes both practice and reframing your process and mentality around what creativity is. For me, that means it’s more like a life-long endurance exercise, running just a few miles a day, than a few periodic marathons that wear my body down, require nipple bandaids, and make my toenails fall off.

To be clear, none of these aren’t complaints. They are simply realities. I believe the mental health conversation needs to span all facets — not just awareness about suffering symptoms and resources, but honest conversations about what life is like on the way back up, and daily maintenance of a mind and body that need it more than others.

I’ll end by asking: How is self-care tiring for you? What do you do to combat the brain drain? What tips do you have for other people dealing with “mental healthcare fatigue?”

So much love,

Joshua Merritt

Written by

is just a dude with bipolar II writing about life and stuff.

Invisible Illness

We don't talk enough about mental health.

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