Managing Menatal Illness through Maslow’s Hierarchy of Needs

In this post I outline all the methods I use to manage the symptoms of mental illness and take steps towards recovery. This will be similar to my Coping With Bipolar Mixed Episodes post but more aimed at mental illness in general than specific bipolar episodes.

I will explain how these work through the use of the theory of motivation of Maslow and his Hierarchy of Needs. This is a theory of motivation that for someone to be motivated specific needs must be met in a sequential manner and I find this works well as a psychological way of managing moods and mental illness. These needs are outlined in the sketch below starting from the bottom.

Psychical Needs

The first section that needs fulfilment are the individual’s physical needs including sleep, nutrition and exercise.

Sleep

When it comes to health, mental or physical, sleep is extremely important. Sleep plays an important role in your body in that this is the recovery time for your body to rebuild itself, this is why adequate sleep is vital for effective workouts as well as the proper nutrition. Just like your arms, legs, back, heart, etc., your brain needs recovery time from sleep too.

Sleep and Mental Illness

This is particularly true if you are suffering with a mental illness as these can affect your sleep patterns and experiences.

Within depression it is common to feel the need to sleep a lot more than usual, this is because the sleep cycle in the brain is reversed and instead of getting two thirds of deep sleep you only get one third meaning you need to sleep for longer overall to rest. It is also however sometimes the case that depression will affect sleep atypically leading to insomnia where you are unable to fall asleep or stay asleep for a significant enough amount of time. Mental illness affects everybody differently and it is possible to experience periods of both typical and atypical sleep symptoms with depression.

Bipolar disorder includes depression and mania, in mania the sleep symptoms are often reversed and you feel very little need for sleep or are unable to sleep due to the racing thoughts and high energy. This is one of the diagnostic symptoms of mania however again everybody is different. From personal experience and what I have researched it is also common that due to the high energy you can feel physically exhausted during mania and feel an increased desire to rest your body, which your mind may or may not allow.

Anxiety also affected my sleep massively, when I was in an episode of high anxiety it was incredibly exhausting to complete even the smallest of tasks some days. Being able to go and buy food, or complete school assignments, or talk to another human being triggered so much fear that once the event was over I would be so incredibly sleepy. The amount of energy required to function even at a basic level when you have anxiety is so high that this wipes you out multiple times a day during the bad times.

Borderline Personality Disorder, similarly to anxiety, can be completely exhausting. When my borderline traits are triggered and the ‘beast’ inside of me is unleased, once the damage is done not only do I end up feeling incredibly guilty and embarrassing but these extreme switched in mood to from anger and frustration to depression and guilt is exhausting in itself, it is a lot to put your mind and body through. I would always end up feeling incredibly sleepy following one of these episodes.

Managing Mental Illness through Sleep Regulation

I have mentioned in previous posts that sleep has a huge impact on my mood and one of the things I do to manage my mental illness. I am not a doctor, this is just what works for me generally with each series of symptoms but everyone is different.

With depression the approach changes depending on whether or not you are functioning. If you are still somehow going to work, doing some things around the house, etc. then the best thing I find is to regulate your sleep to try to get 7-9 hours a night, any less and you will not be rested enough, but any more than that I find I wake up with too much negative energy, anxiety or frustration that I have wasted the day which lowers my self-esteem even further and deepens the depression. By going through the motions of your normal routine as best as you can you start to train your body to get back up to the level it used to be able to function at. However, if you are not functioning then I would suggest getting as much rest as possible, you need to heal as quickly as possible to get back to a functioning level to reduce the amount of damage done to your brain during the depression.

Sleep regulation has been highly effective in managing my bipolar disorder. I recommend the same advice for bipolar depression as I do for normal depression, I also recommend the same 7-9 hours of sleep if possible for mania, I know it’s difficult when we don’t want to sleep but our minds and bodies operate at such speed that adequate rest is essential and will help to soften the depression that follows. Mixed episodes within bipolar disorder is the only time I would recommend going against this advice, in these episodes it is best to allow your body to sleep as much as needed to prevent the exhaustion of depression but as little as needed to prevent built up energy leading to anxiety and agitation. If you are unsure if you are in a mixed episode I outline the DSM criteria and my own experiences of mixed episodes here. 

Both Anxiety and BPD are exhausting in the moment, for these episodes I recommend taking naps when this exhaustion hits for two reasons, one to save yourself suffering the guilt and embarrassment of the aftermath but also to heal from the damage done by the hormones released during anxiety or rage.

Nutrition 

Similarly to sleep, proper nutrition is important to regain and maintain a healthy brain functioning. Mental illness can play havoc on eating habits and make this balance virtually impossible.

Mental Illness and Difficulties Eating

Depression typically onsets with the symptoms of a reduced appetite, and/or a reduced enjoyment of eating. In depression, our brains don’t release the endorphins that it should when we do things that are positive towards our survival such as eating, sleeping, having sex etc. This often results in us not eating enough to sustain proper brain functioning or heal effectively out of depression. It is also possible during depression that we will overeat in an attempt to release these happy hormones in our brains, however the foods that we sill eat will typically be high in fats or sugars and low in nutritional value, low in vitamins and minerals. These foods will do little to help us in recovery and whilst they may spike a short burst of endorphins, the high sugar and fats will cause this to be followed by a crash in mood that can worsen depression further.

Bipolar depression again prevents the same difficulties with eating as regular depression. Mania is also tricky as we can become so obsessed with what we’re doing that we can completely forget to eat when our bodies need refuelling the most because we are functioning so highly. Alternatively mania can increase our appetite which can lessen the problems but it is so erratic it is not healthy to confuse your body with eating loads and then nothing in cycles.

Anxiety can do a number on your stomach, during anxiety attacks I would often feel sick to my stomach and the last thing you want to do in those situations is eat anything. This leads to similar issues as depression as you then don’t heal and recover as effectively as you do. In addition to this under-eating can release adrenaline and other hormones that can make you feel shaky, sweaty and other symptoms that ultimately can make anxiety worse.

Borderline Personality Disorder is a co-morbid disorder which means it is usually accompanied by other disorders including eating disorders, depression, anxiety and bipolar disorder. This combination can lead to complications as outlined as above, however eating disorders each present differently and require medical care and professional treatment in most severe cases.

Managing Mental Illness through Nutrition

The important thing to try to achieve is to eat enough of the right foods to gain the correct nutritional levels to recover. A few tips for ensuring you get proper nutrition and recover from your illness that work for me are

• Drink a smoothie for breakfast. In depression, anxiety, ED’s, mania etc. we don’t feel like eating. By drinking a smoothie it is possible to gain key nutrients and kick-start your metabolism and release endorphins without being too tough on your stomach. If you want real control over your nutrition you can buy a blender and fruits, vegetables and nuts and really go all out with your recipes. If like me you are pressured for time in the mornings and require convenience then I would recommend buying some pre-made smoothies, I personally drink innocent for kids as these are small and not too much to manage in the morning.
• Take vitamins. Whilst fighting depression, mania, anxiety, bpd, Ed’s and so on it can be virtually impossible to force yourself to eat enough to gain every vitamin and mineral required for a healthy brain chemistry. To combat this you can take a multivitamin which can help you top up on any you may be missing.
• Find something that soothes your stomach. Particularly with anxiety feeling too nauseous to eat properly can be an issue. It is useful to experiment and try to find something you can eat in these times that will settle your stomach rather than upset it, for me this is an apple. Works every time at balancing the ph. in my stomach but everyone will be different. I have lost count of the amount of ties people have frustrated me by telling me to exercise and that will solve all my problems, whilst that is not the case exercise plays a vital role in managing mental illness. Approximately 20 minutes of exercise is enough to begin to release endorphins in your brain that will make you feel happier and help to heal your mind. Regular exercise can also help to boost your self-esteem and can provide an outset for hobbies and social needs which I will get to. SafetyThat being said it is so important to recovery that you feel safe and mental illnesses such as depression and anxiety can make you feel quite the opposite, especially if you have developed these or BPD or other disorders through abuse. If you find you feel unsafe I feel there are only a couple of things you can do
• When I started writing this post I wasn’t intending to base it on any theory I was just writing my thoughts but as I went on the thought sprung to mind. I had not originally considered safety needs as my experience with this theory has often been within a business environment which would largely consist of job security, not something I felt needed its own category.
• Studies show the best exercise to combat depression and anxiety and to manage bipolar disorder is cardio, however personally I find I get an extra feel good boost from a good weight lifting session as well as boosting my esteem as I am able to lift heavier and heavier weights. Exercise can also provide a healthy outlet for the anger and frustrations felt within BPD and Bipolar Mixed Episodes. It can form a particularly healthy coping mechanism.

Safety

The next section, safety, is extremely important towards making positive steps towards recovery. With illnesses such as anxiety, depression etc. it is important to feel comfortable and not overwhelmed by your environment to be able to function properly.

1. Change your environment, if this is possible an could make you feel safer by surrounding yourself with a better support mechanism living with friends or family, by reducing pressure of rent or work pressures by taking time off or finding a new job, why would you not do this.
2. Seek professional help, if you suffer from depression, anxiety, BPD or have suffered any kind of abuse I strongly encourage you to seek professional therapy and CBT to combat these feelings if they are unwarranted. In the mean time you can try my approach to changing negative inner dialogue here.

Belonging

The next section of Maslow’s hierarchy addresses the social needs of humans, we all need to feel loved and as though we belong and are accepted amongst our people.

Socialising

Socialising is important to maintain but so difficult when it comes to mental illness, depression can prevent you from wanting to do much or enjoying anybody’s company despite how lonely we feel. Anxiety can make socialising way too overwhelming and exhausting when done even a little bit. BPD can make us not want to socialise because we don’t want to blow up and hurt others and embarrass ourselves. Bipolar disorder can make it difficult to make plans through the mood shifts and stick to them.

My advice is to start out small, go places you are comfortable going with people you trust for short amounts of time to begin with and work up to more as this becomes easier.

Alcohol – A side note. With bipolar disorder some people believe it is a bad idea to drink alcohol full stop. However my psychiatrist has no issues with drinking in moderation. I drink sometimes, I believe and respect anyone’s decision to drink or not drink with mental illness. However I would urge you to be cautious drinking if you are feeling depressed or aggressive or suicidal as these can be exacerbated through alcohol which is the last thing you need.

Outside Support

Another way to seek the feeling of belonging is to feel understood and validated through seeking outside support, from friends, family or professionals. Ideally a mixture of all three would be the most effective providing a range of support in aid of your recovery. It can be extremely frustrating to experience invalidation from loved ones or professionals as I have experienced before, but once you find someone who makes you feel validated it helps so much. I wrote recently about a new friend I met and he has made me feel so validated since meeting him and this has helped me feel so understood, I urge you not to give up on people if you haven’t found this yet.

Esteem

The next section of the hierarchy is to do things to boost your self-esteem.

Hobbies. 

One way to boost your self-esteem and help lift the lows of depression, anxiety, BPD and bipolar disorder is through taking up hobbies. It is not important what these are as everyone enjoys different things, for me I enjoy working out, writing, drawing among other activities. Perusing these hobbies will occupy your time and as your skills progress you will feel better about yourself and your achievements.

Goals 

Alongside pursuing hobbies you should set yourself goals that as you work towards them you will feel greater self-esteem. Be careful when setting goals that these are realistic as disorders such as depression and anxiety can create a number of setbacks when it comes to pursuing goals. Keep goals small and achievable to reap the results of achieving them often but set bigger goals as well to feel you are working with a purpose. A blog I often find useful with goal setting is Zen Habits. 

Self-Actualisation 

Self-actualisation is a state you reach once all these needs are achieved where you are able to self-regulate your own motivation or in this case happiness. With a mental illness however this may not be enough. If you find you are looking after each of these needs and it is not working or you are unable to meet these needs you may need to consider medication.

Medication

Now I am not saying that to reach this state you need medication, but for many people suffering with mental illness especially Borderline Personality Disorder, Bipolar Disorder and Anxiety medication should be seriously considered as a long term approach if the person is truly suffering, in my opinion. This is not to say you will need medication forever, medication provides a baseline to then build on the other needs I have outlined and take steps towards being independent in your recovery.

Routine

Once self-actualisation is achieved a good way to maintain this state is to gain a routine which incorporates all your positive habits towards meeting these needs including an eating, sleeping and exercise routine, regular socialisation and time for yourself and your hobbies. This is also important with work, with a mental illness such as Bipolar Disorder or Anxiety or Depression work is easier to manage if you have a set routine every day or week.

 

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