Author: Ivory Smith Causey
Bipolar mania and bipolar depression can affect hygiene and feelings about hygiene. It can be the first sign of the start of mental health issues. I can remember my thoughts, moods and even thesis statements during mania were: I am going to save money on my water bill by not taking a shower for two days!! There are better things to do than take shower. It is not fun, enough to take shower today. My thoughts, moods, and even thesis statements during depressive episodes were: It’s too much effort. I can’t believe I got to do that shower thing again. Ok, I did one today, but definitely not tomorrow. In the throes of an episode, I have to reason with myself that another day shouldn’t hurt without a shower.
It has been said that cleanliness is next to Godliness. Anything unclean is associated with being lazy, immoral, impovershed, and homelessness. Indifference to hygiene task can include showering, washing hair, brushing teeth, changing to clean clothes. As a healthcare professional knowledge of hygiene and what can happen to the skin when it is not clean is not enough in order to overcome an episode. The opposite actions of bathing others and teaching caregivers to care for loved ones but no hygiene for myself were incomprehensible. It’s not about will power. It’s not about profession.
During depressive episodes there is diminished interest in usual activities. At that time, showering was an ordeal that had to be thought out before doing it. Considering the steps; making sure the water is hot, drying off efficiently, moisturizing, then putting on clean clothes is a lot to handle with deep or even low-grade depression. I looked at all those steps and call them excruciating and say “why bother, I’ll do it tomorrow.” It was no longer an act I performed to keep clean it seemed like each shower was getting ready for spring cleaning.
During a yearlong depression, my hygiene slid down to pretty low levels. It was embarrassing to be told gently by my spouse, “you may want to go and take a shower.” In my alarm, at the time, I saw nothing wrong with needing to take one. I would say that I was sorry and sometimes I would get up and take one. However, as it’s getting late and I’m sleepy, my spouse gives me a break and gently says, “well make sure you take a shower before being around people tomorrow.”
Therefore, I began to try to remember how many times I had bathed that week. A moderately depressed episode was three times a week. As the depression became more severe, I was shocked to realize I had bathed only twice that week. On the outside portrayed one thing and cosmetics and nice clothing can only disguise these symptoms of depression. To make myself take a bath, I would have a conversation with myself. I would say in third person, “Ivory since it is Saturday, and Sunday is the Sabbath then you need a shower that night or that morning” or “Ivory, for two nights out of the week you took sweaty exercise classes then that is a good time to take a bath.” I would also use the day before the start of my work week. I associated it with something else. I was no longer performing dreaded hygiene activities. I associated it with staying healthy, looking acceptable, and just plain self-care.
During manic episodes, thoughts are racing too fast to deal with even a two- minute shower. It seemed as though there was always something better to do. . Delay of gratification for other illicit activities instead of completing the process of hygiene activities can be overwhelming. Since my old fashioned wash ups would occur in the morning the same can happen at night. Washing hands face, and genitals are the only areas I can manage in those states. I have also found that the new popular all over body deodorants which assist with odors can help keep the body fresh. Proactively, keeping adult wipes on hand can assist with keeping clean skin folds and genital areas.
I shared my hygiene issues with two people in my family support systems. Sometimes we joked that I was going to be taken out to the back porch and hosed off, but I am sure me and my spouse’s pit bull mix and German Shepard would not appreciate their backyard show. I also shared this issue with my online bipolar support group. I decided to let down my shame regarding this issue. How can a person get needed help if it’s not talked about? As an old saying goes, “a closed mouth does not get fed.” A member chimed in stating that they went through the same thing. They reported being oblivious or indifferent to bathing as I was. One of my family support systems would remind me to take a shower after I got off the phone, so accountability is there.
I have some suggestions for coping with getting hygiene activities accomplished during depression or mania.
- Associate the act of bathing/showing/or washing hair to the start of something like the beginning of the work week.
- Associate showering with the end of a workweek
- If showering is too much of an ordeal keep adult bathing cloths. These can be purchased at any pharmacy or medical supply store.
- Make an agreement with supporters that a bath/shower/hair wash etc. will be done that day or night. Preferably soon after an agreement is made is best. I have found that if I wait I can come up with an excuse for not taking care of hygiene.
- Splurge if possible, on quality soaps and shampoos to make for a pleasant experience.
- If a day is missed cleanse face and the genital areas for express cleaning and put on clean clothing.
- Develop a routine when stable for hygiene care: morning showers, after work showers, or night showers, or before or after dinner.
I found that I still have to consciously think about hygiene care and when I am going to do it. If I am going to the gym early morning that then means I take a shower there before starting my day.
A person should get help when it is making it hard to function. Moralizing hygiene helps no one. You should not feel ashamed about reaching out to members of your support team. It should be remembered that general guidelines around the products, frequency, hygiene methods can vary by religious or cultural beliefs. In addition to reaching out to a mental health provider reach out to someone within you culture for advice and guidance.
Talmadge, M. (n.d.). Hygiene and Mental Health. Nexus Family Healing. https://www.nexusfamilyhealing.org/blog/hygiene-and-mental-health
Ivory Smith Causey has a B.A. in sociology with a minor in women and gender studies from Georgia Southern University. She has a B.S. in nursing from Macon State College. Ivory is a registered nurse at McIntosh Trail Management in Macon, Georgia and works in an assessment nurse case manager.
