Within my circle of friends and colleagues, conversations about mental health are more common than those dissecting the TV series we’re currently streaming. We quip that our suffering helped inspire our creativity and senses of humour, and speak frankly about our traumas. Yet for all our candour where mental health is concerned, something that’s rarely discussed is our collective fear of experiencing a relapse or recurrence. Which, if we’re all honest, is ever-present.

While I’ve never sought a formal diagnosis, I’ve lived with symptoms of anxiety and OCD for as long as I can remember. Racing heart, intrusive thoughts, restlessness, intense worrying, rumination – the list goes on. There have been periods where these symptoms felt all-consuming; where every second of life felt more overwhelming and catastrophic than the last, and during which I’ve been more frightened than ever before or since. It’s been a few years since I last experienced an episode like this. But the worry lingers that these symptoms may return just as potently – or even more so.

I’d liken it to watching the weather. The sun’s shining, but forecasters say there’s a chance of rain that could spoil your plans. You go about your day, but with the worry that it might end in ruin. For me, this means that every belly jolt is accompanied by fierce analysis (is this temporary anxiety, or something that may trigger the return of long-term symptoms?) and a simmering fear that my mental health will go into a downward spiral any second.

It’s a fear that many can relate to. When Feel Good Club referenced this phenomenon in an Instagram post last month, almost 26,000 people hit the like button. “I rarely hear people talk about how once you’ve experienced depression, it can be absolutely terrifying to feel sad. Having no idea if this is just a bad day or another dive into darkness,” the post reads. “This is a reminder that bad days will still come but it doesn’t always mean you’re slipping again, they can pass as quickly as they came. Be gentle with yourself when you feel like this and remember no matter what, you’re strong enough to get through it.”

One in six people report experiencing a common mental health problem, such as depression and anxiety, in any given week in England. Depression in particular is highly recurrent. Research shows that at least 50% of people who recover from an initial episode have one or more additional episodes in their lifetime, and people with a history of depression will have five to nine episodes in their lifetime on average. 

It makes sense, then, if the thought of relapse (defined as another episode that happens less than six months after you’ve been treated for acute depressions) or recurrence (when a new episode comes six months or more after the previous one) causes you concern.

“If we feel as if we are controlling, or in recovery from, a mental illness, then it’s common for us to continue to feel an underlying fear that the symptoms might return,” says Georgina Sturmer, a counsellor and member of the British Association for Counselling and Psychotherapy. “In many ways, this is a common theme when we are recovering from any illness – whether it’s mental or physical – if we feel as if it’s something that could return. 

“This can make us feel an extra layer of anxiety or dread, or it might make us hypervigilant when we sense changes in our emotions or mood.” It can make any emotions we consider to be ‘negative’, such as sadness or anger, particularly hard to navigate.

If you have a history of anxiety, it can be tricky to know in the moment whether a worry will wash over you or not. Sturmer says a key identifier tends to be feelings that weren’t triggered by a specific event or cause, and those that are persistent.

“Emotions are part of everyday life, whether it’s happiness, sadness, excitement, worry, frustration [or] exhilaration,” she says. “They make us who we are as human beings, and they are a response to what’s going on around us.

“We might start to feel concerned about our mental health when our feelings linger for longer periods of time, or if they worsen. They might not seem linked to a specific cause or event, and they might start to feel like they are part of who we are.” 

Experiencing physical symptoms is another sign that we may not just be having a bad day. The same applies if our mental health symptoms are getting in the way of everyday life, “so instead of understanding that we feel sad because of something that has happened, it feels as if we are experiencing depression, or that we feel that we are a depressed person – it’s become part of our identity,” says Sturmer. 

Ali Ross, psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP), says distinguishing between ordinary worries and a relapse or recurrence is about knowing when you’re out of your depth – and noticing when your personal toolbox of management aids feels insubstantial. 

“If you’re worried about your mental health and struggling to know how bad things are, seek out professional support,” he urges. “You don’t have to be mentally unwell to seek out or benefit from therapy so if you’re asking the question, it’s likely a good time for therapy.”

Personally, I just want to be able to worry and wallow, when need be, without the fear that my mental health is heading for the gutter. I want to feel sadness and frustration and concern and disappointment and embarrassment in peace, if you’ll allow me the oxymoron.

Sturmer says this starts with acknowledging what’s actually going on. “Find a way to voice and explore this, whether it’s through talking to a loved one or counsellor, or using a creative outlet like journaling,” she says. “Notice what might be triggering these feelings now, and if there are any elements that you can take control over.”

She says it’s also important to differentiate the past from the present, and avoid automatically drawing conclusions based on past experiences. “Take steps to untangle how you are feeling now, and how it is different from how you have felt in the past,” she explains. “Develop a toolkit of techniques to remind yourself that you are living in the present, and you are not stuck in your previous episodes of poor mental health. This might involve positive affirmations, visualisations or grounding techniques.”

According to Ross, if you often worry about mental illness recurring, it may indicate that you don’t feel sufficiently understood or supported around your diagnosis. “The best professional support around mental illness is with an ongoing specialist – a psychiatrist, psychologist, psychotherapist or counsellor – and [with] both you and your professionals’ understanding that your ill health will likely evolve over time as your mutual understanding of it deepens. 

“In this way, it becomes less about treating and preventing recurrence and more about understanding how this is part of you and integrating it into your life.”

Frame Of Mind is Stylist’s home for all things mental health and the mind. From expert advice on the small changes you can make to improve your wellbeing to first-person essays and features on topics ranging from autism to antidepressants, we’ll be exploring mental health in all its forms. You can check out the series home page to get started.

Images: Getty