When Mental Illness Affects Your Hygiene

by Kimberly Zapata
A mentally ill woman sitting alone on her bathtub in a beige bathrobe
Carolina Conte/EyeEm/Getty

For most, hygiene is something which is a given. It is second nature; most people don’t think about showering or styling their hair. Most people brush their teeth twice a day — once in the morning and again in the evening — without question. And most people “keep up appearances.” They change their undergarments, shirts, and socks. When they go out, they are put together, through and through.

But when you have depression and/or another major mental health disorder, these tasks aren’t quite so easy. Bathing can feel like a chore. How do I know? Because I live with bipolar disorder, anxiety disorder, and PTSD, and when I am symptomatic — like I am today — I struggle.

It’s been four days since I’ve bathed. My shirt smells like an Italian delicatessen: meaty, oniony, and vinegary. I am potent and pungent, to be sure. My teeth? Let’s just say I went away for the weekend and my toothbrush remains untouched. It is (still) sitting in the travel bag in which it was packed. And my underwear has crusted over. I do not have the energy to remove it, or my black yoga pants.

Of course, I am not proud of this. I don’t think anyone who lives with a mental health disorder would be proud of this. It is a series of symptoms which I rarely talk about. I do not tell my therapist when I am struggling to bathe or my psychiatrist about my unbrushed teeth, but it is a symptom of my illness none-the-less. A so-called fact of life.

“A lot of people struggle to do basic hygiene tasks when depressed,” an article on Healthline explains. “This can include showering, washing their hands, brushing their teeth, doing laundry, or brushing their hair.” And while the reason is complex, Melissa A. Jones — a clinical psychologist based in Indiana — tells Healthline it is mainly driven by a lack of energy, drive, and motivation.

“‘They [people living with mental illness] report not having enough energy to do simple self-care tasks, such as brushing their teeth or washing their hair,’ Jones says. Diminished interest in activities also plays a role.

“I’ve worked with clients who describe their depression as ‘a constant gray cloud,’ ‘a feeling of being stuck under a load of bricks,’ and ‘a heavy weight that makes it nearly impossible to even get out of bed,’” Carla Manly, a clinical psychologist and author, adds. “When you look at depression through this lens, it becomes clear that the actions mentally healthy people take for granted are monumental tasks for those suffering from major depression.”

When I am depressed, I feel helpless and hopeless, like I am stuck in the ocean treading water. I am exhausted by the notion of living, by the act of staying afloat. When I am depressed, I hurt. Mental illness causes physical pain, and the latter makes me avoid both movement and the water. Showers (quite literally) sting. And when I am depressed, I’m apathetic. Nothing matters — that, or it is simply that I do not care.

So I hide behind coats and baggy hoodies. No one will know I’m wearing the same outfit if they don’t see it. I wear masks when I go out to protect me from COVID — and others from my breath — and my short hair is covered with a hat, one which conceals the fact I haven’t washed or styled it for several days.

I am a master of disguise.

Depression be damned.

Of course, I know what you may be thinking — wouldn’t taking care of yourself be easier; wouldn’t it be less work? While that may be true, depression isn’t logical. The thought process of someone with mental illness isn’t rational, and there is no making sense of my symptoms. I simply roll with them, pushing through when I can.

Eventually, I shower. I change my clothes. I brush both my hair and teeth. And I do so because I have been here before and know I have made it through before. Because I know I can and will survive. I do so because I have supportive friends and family, ones who remind me that even the most basic self-care matters. I matter. And I do so because I have an amazing psychiatrist and therapist, ones who know when I am floundering even when I am not transparent. Even if I don’t admit my hygiene flaws.

So if you find yourself struggling to bathe to today — if your hair is in knots and you haven’t been able to brush your teeth — know you’re not a bad person. You’re not a crazy person, and you’re not a lazy person. Rather, you’re struggling. You’re hurting. You’re in pain. But there is help. There is hope. With time, meditation, medication, and/or therapy, you can make it through. Just reach up. Reach out, and ask for help.