By Ivory Smith
Most of us have heard the saying: “Cleanliness is next to Godliness.” This old-fashioned mantra reinforces a long-held, misguided belief: that being “unclean” equates to laziness and moral ineptitude. As a result, our culture often takes an unsympathetic approach to addressing issues like poverty and homelessness; far too many of us interpret these situations as a personal failing rather than a product of structural inequality. And, significantly, our ideas about the morality of cleanliness can shape how we view mental illness.
Hygiene is one of the many symptoms that is frequently left out of the mental health conversation. This is largely because the subject is difficult to talk about — many of us feel the weight of stigma when talking about our bodies and our personal habits. However, indifference to hygiene tasks, including showering, brushing teeth, doing laundry or brushing hair, is a common symptom of mental health conditions (particularly depression).
As a health care professional and someone living with depression, I can speak to the very real manifestations of this symptom. My personal understanding of hygiene and my professional understanding of germ theory was simply not enough to beat the confines of a depressive episode. As I bathed others and taught caregivers, I, myself, struggled to take a shower. This was difficult to wrap my head around, but I have come to understand that neither a professional designation, nor “knowing better,” can shield you from mental health symptoms.
In my work in the health care profession, I have found that difficulty with hygiene tasks can be an early warning sign of mental illness. I have seen how bipolar disorder can present in its early stages in the form of changed feelings about daily hygiene practices. This symptom can seemingly come “out of nowhere.” When bipolar depression or mania are looming, symptoms can come in like a roaring tiger — or they can sneak up gently and go unnoticed until you find yourself in the pit of the deepest valley.
Hygiene issues can also appear during more advanced stages of mental illness; I have even witnessed patients in psychosis experiencing irrational thoughts about hygiene. I have also seen how major depression can extend to hygiene practices. When experiencing the crushing weight of depression, showering can feel like an ordeal that requires exhausting amounts of forethought and effort. The number of steps feel intimidating; making sure the water is hot, washing everywhere, drying off efficiently, moisturizing, then putting on clean clothes can feel like a lot to handle with deep depression.
When I was struggling, I found those steps to be excruciating; I would often say, “Why bother, I’ll do it tomorrow.” Suddenly, showering felt like a huge task — like doing an entire spring cleaning of my house every day.
During my year-long episode of depression, I saw firsthand how hygiene could fall by the wayside. And I was not even fully aware that my habits had changed.
I was embarrassed when my spouse told me, gently, “You may want to go and take a shower” or “Make sure you take a shower before being around people tomorrow.”
I would say that I was sorry, and, sometimes, I would get up and take one.
I began to keep track of my bathing habits so I could get a clearer picture of how my depression was impacting my hygiene. A “moderately” depressed week usually accompanied three showers a week. As the depression became more severe, I was shocked to realize that I had bathed only twice that week. Things I once enjoyed like pedicures and facial grooming faded away.
To make myself bathe, I would have a conversation with myself. For example, I would say (in third person), “Ivory, since it is Saturday, and Sunday is the Sabbath, you need shower that night or that morning.” Or I might say, “Ivory, since you take very strenuous exercise classes two nights out of the week, then that is a good time to take a bath.” Essentially, I attached bathing to something else I was already doing. It was no longer performing hygiene activities; I associated it with my manageable everyday tasks as well as staying healthy.
I also shared my “secret” with two family members and my bipolar support group members. Several people in the group chimed in, saying that they went through the same thing. They reported being oblivious or indifferent to bathing. One of my family members helped by reminding me to take a shower after I get off the phone with her — and we turned this practice into a “deal” I would make with her when I was struggling.
For those who are struggling with the effort to maintain hygiene, I have a few suggestions:
When we are having difficulty functioning, we deserve help. Struggling to practice hygiene (even when you know you “should”) isn’t a moral failing; it’s simply a sign that we need extra support. You should not feel ashamed about voicing your struggles and reaching out to members of your support team. This journey can be difficult, but you don’t have to do it alone.
Ivory Smith Causey has a B.A. in sociology from Georgia Southern University and a B.S. in nursing from Macon State College. Ivory is a registered nurse at McIntosh Trail Management in Macon, Ga. and works as an assessment nurse. She is a member of the American Holistic Nurses Association and hopes to be certified in holistic nursing.
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