While this isn’t a topic discussed very often, hygiene is one of the elements often noted by psychiatrists and therapists when diagnosing or tracking depression, bipolar disorder, schizoaffective disorder, and schizophrenia in patients. Poor hygiene can be a big indicator of depression, psychosis, or mania, and I thought today I would discuss my own experiences with this a little bit.
The simplest place for me to begin is probably with depression. I often use a three-tiered rating scale for my depressive symptoms, where a 1 is considered mild and a 3 is quite severe.
My hygiene usually starts to slip in phase two. At that point I have been struggling to keep up with things like daily chores, social situations, and my motivation might be completely devoid or I have lack of caring for most of the things going on.
When I feel overwhelmed and like I can’t catch up with all of the things I am supposed to be doing, it usually means I start cutting corners. I’ll eat my eggs with a spoon so I don’t have to do the dishes. I’ll wear the same thing every day for a week so I don’t have to figure out a new outfit. Likewise, my time in the shower will start to slip from every other day to every three or four days.
Part of it is about not feeling like I have enough time to get everything done, but another part is simply about not wanting to. When I am forcing myself to attempt to get the dishes done, it takes a lot of time and energy to do so. Generally the more depressed I get, the less energy and motivation I have. Activities that may have happened on a daily basis become less and less frequent, and that includes everything from leaving the apartment to showering.
Another aspect of the hygiene problem for me comes from the shower itself. If I am on the couch I might be able to keep my mind somewhat occupied by the TV. If I am in bed I could try to read a book. When I’m in the shower though, I am left entirely with my own thoughts. If I am depressed and take a shower, I feel almost exclusively worse coming out than I did going in. So what do I normally do in regard to triggers? I avoid them.
When phase 3 of depression rears its ugly head it means I am grappling with severe suicidality. Every minute feels like a constant battle with myself, and I care less and less about the things around me. In this place it is far more than a lack of motivation that keeps me from taking care of myself, it is like being caught in a net in my own mind, and if I don’t spend every waking moment trying to free myself from that net I will be trapped there forever.
When that happens, good hygiene is not even remotely on my radar. Everything external became extraneous, and I can’t help but be convinced that shaving my legs wont have anything to do with making it through the episode alive.
As far as mania is concerned (as I can perform everything fairly well while hypomanic) the issue is similar to phase three of depression, except that attention that I have turned inward when suicidal is turned outward when I experience mania. The attention and focus I have on one small detail often consumes me, and my priorities around normal external things (like sleep, eating, bathing) evaporate. It isn’t about losing motivation, on the contrary -I find my motivation so consuming I can’t think to focus on anything else.
Similarly, there are times when I am manic where I feel sort of above the law, if you know what I mean. Something larger or more meaningful than the average person, and in those moments I can say that my slightly delusional mind finds basic hygiene below me.
The issues I have regarding hygiene and psychosis might only really make sense if you have experienced it. There have been times where I have felt so paranoid and fearful that standing behind a shower curtain (and not being able to see what is on the other side) is impossible. Other times I have feelings of violence and rage so intense I don’t feel comfortable leaving my room or the presence of another person… which puts bathing somewhat out of the question.
Honestly, I think the issues we face in regard to maintaining good hygiene is not something understood by most people. Those that have not experienced the entanglement of depression, the overwhelming focus of mania, or the abrupt fear of psychosis may fail to grasp how difficult it can be to focus on oneself and follow through when there are so many symptoms guiding me away from bathing or changing my socks or brushing my teeth.
I guess I just wanted to make a point of explaining that poor hygiene isn’t always a product of laziness or a brazen lack of adherence to social standards. There are times when a lack of energy or motivation can put the kibosh on taking care of our hygiene, as well as times when our symptoms are severe enough to engross us so fully that our goal is merely survival and nothing more.
In a society where a “bad” outfit or poor hygiene can make one the product of ridicule, I think it is important to remember that there may be factors in any given person’s situation that we may not know about. When people can be so quick to judge, sometimes I feel like the most support can come from the person who simply gives me a break.