Getting Back on the Horse

Getting back on the horse

I often hear the following remarks from clients, especially after something bad has befallen them:

  • “When I am ready, I will have that difficult conversation.”
  • “When I have gotten better, I will start doing things that I enjoy again.”
  • “When I have fully healed, I will go back to work again.”
  • “When I am stronger, I will start connecting with people again.”
  • “When I am less depressed, I will go for a walk again.”
  • “When my anxiety is under control, I will return to my uni classes.”

Of course, there is validity in these statements.  That is, after all, how it works when our bodies get hurt. No-one will expect you to walk if your broken foot has not healed yet, and no-one will bat an eyelid if you stay home for weeks after having had a heart attack. With emotional pain, there is also much to be said for taking some time off to rest and heal before resuming normal life again. (Bereavement leave is a great example of this.) In my mind, the following picture represents this way of reasoning: 

Although there is much value in taking some time off when you are mentally unwell, or de-stabilised by a traumatic event, I think there is a caveat that deserves mentioning. Like with physical injuries, our mental health actually deteriorates if we cross that threshold between “long enough” and “too long” – almost like experiencing muscles withering away if a person is physically inactive for too long. There are certainly a fair few psychological problems with withdrawing from normal life for longer than is needed:

  • It can be quite isolating to take a  lot of time off – no longer is the client part of work life, sport life, school life or even social life. Feeling connected to others is part of the very fibre of mental wellbeing, and excessive time off actually takes away something that could have had a rather positive and healing effect. Going back to work sooner rather than later after a traumatic incident, for example, serves two valuable purposes – the client is able to feel that he/she still adds value to society by working, and the work itself can often serve as a few hours of respite from whatever the problem is.
  • Occasionally people can get stuck in a narrative of themselves as unwell, as not ready, as not able, and as not competent to go back to normal life. The longer this storyline of “I cannot” stays fixed in their minds, the harder it gets to actually start making steps to resume life as they knew it.
  • The goal posts can be ever shifting: maybe today my client feels she will be ready by next week, but by next week nothing has really changed, and she shifts out her dates by another week… and another week…
  • If there was a traumatic incident – be it a car accident or a bullying event at work – clients can develop acute stress disorder (within 1 month of the incident) or even post-traumatic stress disorder (lasting longer than a month post incident). One of the key features of both conditions is that avoidance often comes to the front as the mind’s number 1 way of protecting the person from potential further injury, be it physical or psychological. If the horse threw me off, I would surely be silly to get back on again. If I fell off my bike, surely the safest place for me is NOT on it again! The problem with this reasoning is, of course, that not doing things like getting back on the bike, going back to work after an altercation, or getting in a car again after a motor vehicle accident is that it will seriously impact the quality of my life. And the longer I don’t do it, the harder it gets to do it. Avoidance only alleviates anxiety for a short moment. In the long run, avoidance actually always makes anxiety worse.  
  • The concept of “secondary gain” might also come into play: if a person is still getting paid a full salary without being at work, or if a lot of attention and special care are lavished on the unwell person, these things can serve as motivational factors NOT to get better quickly. This is usually not done intentionally by people, but can be an additional rewarding reason for people to be slow to lean into a narrative of mental health again.

So… what I usually propose is a different picture of the relationship between healing and re-entry into normal life. Rather than having one line with a strong threshold and division between “not ready” and “ready” I draw it like this:

The process of “getting better” can happen at the same time as the process of re-engaging with normal life. Not only do the processes happen simultaneously, they also inform each other. Getting better makes one engage with life more, and engaging in life more helps one get better.

This sometimes requires of us to push ourselves a little bit. In treating clients with anxiety, I often emphasise that the point of the intervention is not to make the anxiety go away, and then do the thing I have to or want to do, but to do it even with the anxiety still present. In other words, I am holding both narratives (“this is hard” and “I really want to be able to do this”) at the same time, but choosing to lean into the one that aligns more with my values, my hopes, my sense of self. Hopefully, as time goes by and the image in my mind of myself as an able and competent adult gets strengthened by real-life experiences, the job does get easier and the anxiety does go down!

For health professionals it is tricky to get the balance between “just enough” and “too much” just right – of course one has to have sympathy with time taken off for mental health reasons, but at the same time there should be an acute awareness of how time off can actually exacerbate mental health problems. GPs specifically would ideally have a good sense of this concept, certainly booking off patients if need be, but being very careful to give lengthy sick day extensions to people who are anxious, sad or traumatised. Helping people compassionately back into their normal lives will actually be the best antidote to anxiety, depression and trauma (given that there are no significant risk factors with regards to suicide, self-harm or potential harm to others, of course).

To get back to our horse riding analogy: If you “fall off” in the sense of feeling mentally destabilised or significantly upset, take a moment and assess your “injuries”. If you are able, get back on the horse as soon as possible! Then the narrative of resilience and courage will triumph over the ever-shifting goal posts of “not quite ready yet”.    

Lindie Oppermann
Felix & Sage Psychology

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