Recent reports show a worrying increase in mental problems for people with HIV. But don’t despair, says psychotherapist Keith Bishop, there are lots of ways back to good mental health
As a psychotherapist and complementary health practitioner
I see a person’s mental and emotional well-being as the linchpin that
holds together their physical health on one hand, and their ability to open
up spiritually and emotionally on the other.
Life today is extraordinarily stressful. Whether you’re trying to stay sane on a crowded tube, coping with unemployment or asylum issues, or trying to hold a family together, the stress can be enormous. Add in the political and social situations that threaten our planet. And then, as icing on the cake: HIV.
With all of that to contend with, it is no wonder that some people’s mental health may start to crumble.
The very phrases ‘mental health’ and ‘mental illness’ are so loaded with stigma and misunderstanding that, just when you may be in most need of help, the shame of taking on yet another label can be too much to bear.
When we hear the phrase ‘mental illness’, we associate it with the shocking stories the media like to report. People going psychotic in public and wielding knives and guns, or people so paralysed by depression that they have not been able to leave home for years. So with images like these in mind, it’s not surprising that it can be almost impossible to acknowledge that you may not be doing so well psychologically, and that you might need to ask someone for help.
Thanks to antiretroviral treatment in the UK, most people living with HIV have something that effectively maintains their physical health and keeps the virus in check. But what about the side effects? What about when combinations begin to fail? What about adherence issues? And what about those newly-diagnosed? And those who have lived with the virus for many years? And what about people who come from countries where Aids equals Death? What if you feel all alone?
The psychological aspects of living with HIV (or any potentially life-threatening
condition) are extremely complex. Receiving a diagnosis can be hugely shocking,
both emotionally and physically, and people can feel terror, deep anxiety,
sleeplessness, loss of appetite, anger, rage, numbness and despair, usually
in quick succession, and often unpredictably. Agitation and inability to settle
or focus on something can quickly be replaced by feelings of lethargy and lack
of hope. Stress becomes a major issue and can be expressed mentally (repetitive
thoughts, for example, or not being able to read or watch TV) or physically
(tense shoulders, headaches, lower back pain). Because the mind and the body
are so inter-connected, this stress can affect the body, diminishing the immune
system further.
Living with HIV long-term can bring other additional problems. Depression
is extremely common. It is often accompanied by a feeling of being ‘heavy’ and
weary, both emotionally and physically, but the flip-side can also be true,
with some people feeling irritable, agitated, tense and unable to concentrate.
Issues around self-esteem can become central. People may often feel worthless, hopeless, useless, ashamed, ‘dirty’ and deeply alone. Add to all this issues that may be related to being unemployed long-term, in a work or study environment that doesn’t feel supportive, or being separated from friends and family abroad. No wonder some people feel disturbed.
And no wonder then that a recent report by Sigma Research highlights the need for appropriate psychological support for people living with HIV. (What Do You Need? is available from the website: www.sigmaresearch.org.uk)
In more extreme cases of mental disturbance, people may act out their feelings of despair, frustration and worthlessness through self-harm (such as cutting themselves, over-eating, excessive use of alcohol or drugs, or non-negotiated unsafe sex) and may even contemplate or, indeed, attempt suicide.
But it’s not all doom, gloom and hopelessness.
The first stage in dealing with any psychological or emotional problem is admitting it to yourself. Friends and family may hint at their concerns about your well-being, or may be more blatant. (A note here: telling someone they ‘look like shit’ and ‘need to get their act together’ is rarely useful.) But until you can actually acknowledge to yourself that things are not going well, you won’t be in a position to get the help you may need.
As a psychotherapist I’m kind of big on the whole ‘talking’ thing. If you’ve got good friends and family around you and feel able to share your thoughts and feelings with them, great. Feeling isolated can be crippling, so talking to someone you know and trust is a major first step on the path to wellness. The alternative is to see a professional. Counsellors, psychotherapists and clinical psychologists are available in most health trusts, and many HIV and mental health charities offer free or low-cost therapy. Counsellors tend to see people short-term (six to 20 sessions, for example) and often focus more on the ‘here-and-now’ issues.
Psychotherapists usually see people longer-term and can help you to explore the more deeply-rooted issues and concerns.
Clinical psychologists will generally offer very short-term work that focuses on specific cognitive or behavioural issues (such as phobias or controlling self-harming behaviours). The relationship between you and your counsellor or psychotherapist is very important and you may want to try a session with two or three before you find one that ‘feels right’. It is vital to be working with someone you trust and feel comfortable being open with.
Group therapy is also an option in some areas and, again, the choice of group and facilitator is significant. You may need to consider whether you want to be part of a group just for people living with HIV, just for gay men for instance, or just for people from your own community.
In more extreme circumstances, you may get a referral to a psychiatrist. This person will be a medically-trained doctor specialising in mental health and will primarily offer you some form of medication. This, too, may have side effects, so it is important you ask what these might be and how to manage them. They can also interact with any anti-retrovirals you may be taking, so it is vital that your psychiatrist knows of your HIV status. If you have any concerns, share them with your HIV consultant.
Apart from talking, and taking conventional medication, alternative and complementary therapies can have a profound effect on mental and emotional health. Treatments such as acupuncture, herbal medicine, aromatherapy*, shiatsu, massage, and reflexology are all enormously beneficial and widely available (often at low cost through HIV and mental health charities, or via training schools and local colleges).
 Paul Merton and Patsy Palmer join Mind Out’s mental health campaign for young people. At: www.readthesigns.org |
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Although there is little scientific research to substantiate the reported benefits of alternative remedies, my personal recommendation is that if you find a therapy and/or a practitioner that you like and it works, stick with it. Again, it is important to be open about both your HIV status and any psychological or emotional issues you have, so that the practitioner can tailor the treatment specifically to your needs.
Physical activity can also be beneficial for mental health. Whether it’s a walk in the park, a workout at the gym or swimming, research shows that getting active can have a positive effect on your mind, as well as your body.
Yoga practice, with its underlying philosophy of unifying and calming the body and mind in readiness for spiritual awakening, has proved to have a positive effect on lifting depression and decreasing anxiety. Although yoga is the flavour of the month at the moment, it is worth looking for a class that is taught by a teacher who includes the core philosophy and doesn’t just treat it as another exercise class. T’ai Chi can also be beneficial in its quiet focus on breathing and steady flowing movements.
Managing your physical health is obviously a major priority, but attending to your psychological and emotional well-being is vital, as is opening up to your spiritual path, if that is important to you. The way you do this and balance and harmonise these three key areas of your life are going to be unique to you. Like finding the right combination of antiretrovirals, finding the right way of feeling well emotionally is going to be specific to you. The most important thing to hold onto, whether you are in the depths of depression and despair, or the heights of agitation and stress, is that you are not alone. Many people living with HIV experience psychological and emotional difficulties, either briefly or as an ongoing symptom, and there are many skilled professionals available to help you find a way through it. It takes courage to heal.
As Frasier says, ‘Good mental health!’
Keith Bishop is a psychotherapist, complementary practitioner and Counselling
Services Manager for Islington MIND.
Many local branches of MIND offer free or low-cost counselling and psychotherapy
for people living in their borough. Islington MIND can be contacted on 020
7272 6797.
*(For die-hard aromatherapy fans, like myself, I strongly recommend The Fragrant Mind by Valerie Ann Worwood)
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Sixty per cent of people with HIV in the UK live in London. A recent report by the Mayor of London’s office found that 23 per cent of all inpatient admissions in the capital are for schizophrenia and delusional disorders, compared to 14 per cent in the rest of England overall. It adds: “London has a large minority ethnic community, including a very high refugee population, which can be over-represented in requiring mental health services.” Studies find consistently high rates of depression and other indicators of poor mental heath among people with HIV. Gay men and refugees are disproportionately affected. An Australian study recently found that 54 per cent of a group of 460 HIV positive gay men either had major clinical depression (28%) or ‘dysthymic disorder’ (26%), which means a long-standing but less severe ‘blue’ mood. In the UK, a recent study by MIND found that two-thirds of lesbians and gay men had experienced depression, self-harm or suicidal thoughts at some time. Last year the Sigma What do you need? Survey (see below) found that although the majority of respondents were ‘fairly happy’ with life most of the time, two-thirds of them had had a depressive episode over the previous year. Half of them reported sexual dysfunction problems, and 30 per cent reported problems in at least one of the following areas: self-confidence, managing money, eating properly, drink and drug intake, or self-care and doing chores. HIV positive women are not immune either: a study at St Bart’s Hospital found that a third of female HIV patients reported depression and over a half reported anxiety. |
Counselling services
Complementary therapies
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