She curses during our sessions, a habit which I suspect she has adopted in order to make herself more relatable to me, which I appreciate. She is based in Durban and I in Cape Town; in these periods of geographical separation, we conduct our sessions over FaceTime. So hip, so modern, so young and relatable – it’s wonderful. Still, there is a singular quality about my doctor that prevents me from trusting her counsel implicitly: I fear that she is completely sane.
Sane people are well-meaning in their conduct with the less-than-sane, but you people just don’t get it. In the long years that I have spent living with mental illness, I have endured a lingering poison cloud of ignorance and stigma that settles and seethes around issues faced by the mentally ill.
Although anxiety, depression and eating disorders have received a fair amount of highly romanticised publicity thanks to the indomitable internet presence of socially conscientious Tumblr users, I have discovered through engagement with sane friends and family that there is an entire world to mental illness that you are woefully ignorant to.
The sane cannot understand
This is hardly anybody’s fault. The channels of communication between the sane and the insane are fraught with paradoxes: the sane cannot possible understand or empathise with the very complex struggles of the mentally ill without experiencing or at least witnessing these struggles themselves.
The mentally ill, however, are notoriously tight-lipped about the details of their disorders. The reasons therefore are many, but they are simple. I believe that this culture of silence is created by the simple fact that nobody wants to be crazy. It is difficult to share the details of our sufferance with anybody because the shit that we go through is truly fucking terrifying, and entirely alienating. Nobody tells you that living with a mental illness makes for uncomfortably awkward conversations:
Friend: “Morning! How did you sleep?”
Me, raccoon-eyed and twitching ever so slightly: “Fine, yes, fine. I mean, for the two hours of interrupted sleep that I did manage to catch in spite of my chronic insomnia. I only had one lucid nightmare in which I dreamt that the pork roast sizzling in the oven was actually the butchered carcass of my youngest brother. There was also a period of about three hours where I lay paralysed in an icy sweat thanks to a night terror, but I broke out of it when I leopard crawled to the bathroom so that I could keep vigil at the window and make absolutely sure that the shadow crouched at my bedroom window was indeed a branch and not a serial rapist.”
Me, haphazardly spooning sugar into my orange juice: “What really kept me up was the persistent muscle spasms that I suffer as a side-effect of my anti-psychotics. I kicked like a frog in hot water, ha! Ha ha!”
More horrified silence.
Me, tearing my nails trying to pry open my infernal pill-box: “My boyfriend won’t sleep in the same bed as me anymore. In fact, all of my relationships are unravelling. It’s fine though, everything is fine. I’m going to take a few Dopaquil, I’ll see you after ten hours of dreamless sleep when I wake up inexplicably exhausted, and we can have this conversation again at dinner.”
Horrified silence deepens.
Me: “Good talk.”
Nobody wants to hear that. Truly, I don’t blame them.
Oppressively alienated and alone
Tragedy strikes when the mentally ill (especially those who are not in any kind of therapy) are so oppressively alienated and alone in their own homes and social circles that they are plummeted irretrievably into the darkest circle of depression, the sole escape from which appears (to the deeply depressed) to be suicide.
Depression is an insidious disease that totally isolates the sufferer from the rest of the world. Social isolation is due in part to the debilitating symptoms of the disease – typically chronic exhaustion and a loss of interest in pretty much everything – but also in larger part to the fear of a stigma.
Although the understanding of mental illnesses has improved vastly since the era of electro-shock therapy, it is not all that much easier to live with mental illness in the 21st century. Even now, I have friends who have viewed my depression as a bizarre bid for attention. They have mistaken my symptoms and side-effects as outright rudeness.
They could not understand why, even after months of chemical therapy, my behaviour was not noticeably improved. When I came out to my close friends about the worst depressive episode I have endured to date, the overwhelming reaction was one of trite sympathy followed by a deafening silence on the matter. Most people just don’t know what to say, or do.
Disorder of the brain
I think that the first step to understanding clinical depression is to understand it as a disorder of the brain, in the same way that diabetes is a disorder of the pancreas. Clinical depression is vastly different from the depression that comes as a result of deep emotional trauma, such as the death of a loved one. The experience is very similar, but the cause and the treatment is entirely different.
Clinical depression is the result of a chronic chemical imbalance, namely a big fat lack of serotonin. Anti-depressants are not happy pills. They do not make a depressed person happy, they make a depressed person normal. Chronic depression is a lifelong disorder that requires ongoing medical treatment, just like diabetes.
Therefore, sufferers of chronic mental illnesses (almost all of which feature clinical depression, hence the focus on such) require much, much more than a gentle pat on the back and the jovial issuing of well-meaning advice. Here, I pause to reflect on the tropes that I have had beaten relentlessly into my auditory canal, and the responses that flashed silently in my head:
“Go for a run, Mia. Exercise will make you feel much better.”
Yes, I’m sure. If only I had had more than four hours of fractured sleep in the last two weeks to muster up the energy to walk down the fucking stairs without folding into a foetal position on the third landing and crying from sheer, desperate exhaustion. Perhaps then I could go for a scenic jog around Rhodes Memorial without fainting and rolling down the mountain like an unconscious burrito for the benefit of a gaggle of camera-wielding Japanese tourists.
“Come out for dinner with us, a square meal will do you good!”
I’d love to, if I was currently in the habit of consuming more than a cup of sugary coffee and a popcorn kernel as a meal, which I am not. I would also have to request that we time our excursion so that we receive our food at precisely 6.30, when I need to take my next lot of meds with a meal. Due to the crippling nausea that is a charming side-effect of said medication, I will also most likely regurgitate my R65 burger in the dimly lit restrooms 45 minutes after eating it, which is why I have a toothbrush in my handbag, thank you for noticing. No, I will not come out for drinks afterwards. My doctors don’t want me to mix mind-altering drugs with alcohol for some godforsaken reason. They just don’t want me to have fun, the stingy bastards.
“Have you tried yoga? You should try yoga.”
Yes, I have tried yoga, you hemp-wearing hippie. I fucking love yoga. My chakras are more aligned than the planets were at Beyoncé’s birth. I fully believe in the physical benefits of yoga, but it is not a cure for depression. I know, because a deep-breathing meditation once sent me spinning into a full-blown anxiety attack and I was forced to go home for two weeks to readjust my meds. I also nearly beat my yoga instructor to death with a sweaty yoga mat when he insisted that my frantic heartrate and non-stop bawling were simply my body’s way of flushing out toxins, and that I ought to finish the meditation to achieve inner peace. My veins are replete with toxins, my friend. They’re from the mood stabilisers that stop me bashing people like you into ICU.
“Just start the work. You’ll feel so much better once you actually get something done.”
I have to agree with you there. There is only the minor issue of my tranquilliser, which not only induces 12 hours of sleep a day but also gives the effect of having a small hominid operating a fog machine in my head. I have read the page of this journal four times over and I still cannot recall a single detail about the social ramifications of French missionary teachings in the Congo. I have also clean forgotten to attend a play I was meant to watch for a Drama assignment, I have recently discovered that I left a washing load in the tumble dryer for four days and I have been staring, uncomprehending, at a pair of starlings on my windowsill for so long that they have deigned me an unmoving statue and have shat all over my left shoulder.
Patience and love
Being an ally to a mentally ill person requires an inordinate amount of patience and love, and not everybody is up to the task. Mentally ill people enduring an episode are shitty people. We are impossibly moody: we become disproportionately sad, angry or anxious over normally neutral affairs. We moan that nobody invites us out any more, and then we flake out on plans, we leave early or we just park off in a lonely corner looking desperately morose, bored and anti-social. We berate our friends and family for not understanding, but we often don’t make ourselves well understood.
We rarely answer your texts or phone calls, and we aren’t particularly sympathetic when you have a fallout with your significant other or when a tutor gives you a bum mark. It is selfish behaviour, but self-preservation is selfish.
I know that this must feel infuriatingly unfair, but the relationship between a mentally ill person and a sane person in these trying episodes is something like that between a drowning person and a person holding a flotation device in a boat. Someone who is drowning has very little concern for the well-being of the person in the boat. For the drowning person, all of their energies are consumed by treading water for another hour until they are close enough to get onto the boat.
Even if there is a leak in the boat, the drowning person is not particularly sympathetic to the issues of the person with a flotation device in a leaky boat. A leak in the boat for the person with a flotation device may be highly distressing, and it is a distressing situation; however, the drowning person isn’t going to offer much in the way of support. The drowning person is more likely to offer something along the lines of, ‘Stop blubbering about a bloody leak in the boat and chuck me a fucking lifeline, you selfish prat.’
Moment of drowning
Pain is relative. For a person dealing with a leak in the boat, the leak is the worst thing happening to them at that moment – this is entirely acceptable, and allowed. But a drowning person cannot think that far ahead. In the moment of drowning, nobody gives a damn about the leak in your boat, they just want to tread water long enough to make it onto the boat alive.
The thing is, if you do extend a lifeline, and if you have the patience to allow your drowning friend as much time as they need to focus on treading water before they focus on the leak in your boat, soon you’ll be in the same boat. How neat is that for a long-winded metaphor?
One of the most grievously misunderstood aspects of mental illness is the nature of its treatment. I know that I said that mental illness is a disorder like any other bodily ailment, but it is not treated in quite the same way. For one, it is incredibly difficult to get a hold of a good psychiatrist.
The waiting list to see head doctors can be up to months long, during which you time you are either expected to deal with your mental illness without medication, or opt for a prescription from your GP, who can prescribe psychiatric medication for up to six months as a stop-gap measure. The latter option is somewhat risky, as a general practitioner is not specialised enough to accurately diagnose and treat mental disorders. Some psychiatric medications, when incorrectly prescribed, can drastically worsen the mental condition.
Ironically, the fastest way to see a psychiatrist is to attempt suicide. After an attempt, and especially if you are committed to a psychiatric ward, you are under the intensive care of psychiatric professionals. The first step toward recovery is typically being stuffed with enough anti-depressants, mood stabilisers, tranquillisers and anti-psychotics that you become a zombie.
Having watched one of my own family members go through this initial stage of the recovery process, I can attest to how terrifying it is to have a once animated and occasionally happy human being switch off into a monosyllabic zombie without an appetite, without a sense of humour, and without a trace of their original personality.
The zombie state lasts for months. The idea is to keep a suicidal patient as complacent and as neutral as possible, so that they no longer pose a danger to themselves. In the meantime, they are subjected to intensive psychoanalysis and traditional therapy, so that the root of the issue may be unearthed and a long-term solution may be found. This, too, lasts for many months. The process is even further protracted by shopping around for the right psychiatrist and/or the right therapist, not to mention the right medications.
Disorders of the mind are intricately interconnected and somewhat nebulous: they are difficult to correctly diagnose, and more often than not, they come in pairs. Major depression and Generalied Anxiety Disorder (GAD), bulimia nervosa and obsessive compulsive disorder (OCD), bipolar II and attention deficit disorder (ADD) – there is a plethora of saucy combinations to keep the mentally ill and their doctors on their toes.
Mental illnesses are much more nuanced and require more highly-tuned treatment than most bodily ailments. Medications that work wonders for one patient may be disastrous for another: each body reacts differently to the side-effects of psychiatric meds, and there is a long list of side-effects. Lexamil made me yawn all the time, so much so that I nearly adopted a permanent placard explaining to the people that I was talking to that they were not boring me.
Cilift made me even more depressed than I was, so that I became suicidal. As an emergency measure, a family member’s psychiatrist put me on the same meds as them without a consultation, in the hopes that our genetic similarity would make them work in my favour. Brintellix stabilised my moods, but it gave me debilitating nausea.
Risperlet took away my nightmares, but it also made the muscles in my legs and arms spasm uncontrollably. Dopaquil sunk me into twelve-hour sleep cycles, and Dormonoct made me embarrassingly forgetful. Anything with lithium in it makes you gain weight. I have seen the horrifying effect of a psychiatric drug which gave a boy phantom itches, so that he unconsciously gouged deep red furrows into his arms.
Despite the awful side-effects, psychiatrists will insist that you endure the treatment for at least a month before regrouping to observe any changes. Normally, it takes about a month for anti-depressants and anti-psychotics to even begin effecting any change. Sometimes, your body adapts to the medicine and all you may require in the near future is a tweaking of the dosage. If you are seriously unlucky, your body will go into toxic shock. Then, it’s back to square one for you, and several more months of trying out different meds and different dosages until you find the one that works for you.
From this compressed description of the treatment process for mental illness, it is clear that mental illness is not the kind that can be treated with a course of pills and a good night’s sleep. The road to recovery is long and winding, and that’s for people with strong support systems and medical aid. I cannot begin to imagine, let alone explain, how challenging the path must be sufferers of mental illness without the luxuries that I have been granted on this already treacherous journey.
I have seen a lot of people, sane and otherwise, implore of their sane peers to just be there for people with mental illnesses. This little ditty is sweet and easy to remember, but it’s not very helpful. I cannot speak for all people with mental illnesses, but I can list the things that my friends and family have done, or things that I wish they had done, in order to be of help:
Keep inviting us out to stuff. We may not come, we may leave halfway through, we may not even reply to your offer, but we see them. We see them and we appreciate being wanted when we feel like the most unlikeable and unworthy people in the world.
Don’t be afraid to ask questions. Mental illness is not a taboo subject, and conversation about the issues that we face needs to be opened up. It’s not an embarrassment to be mentally ill, but it is if you treat us that way. More often than not, you’re not being nearly as insensitive as you think you are when you ask about what we’re going through.
Please, please answer your phone. Taking a call or a message from a mentally ill friend, however distant and cold they may have been towards you in recent times, could very well save their life. I cannot emphasise this enough.
Do not tell your mentally ill friend to just go for a run, just eat a square meal, just try yoga or just get some work done (See above. I will personally wallop you with a sweaty yoga mat).
The mentally ill require a lot of space and time to ourselves to heal, and we are notoriously anti-social. I have a friend who gave me a lot of personal space when I was struggling with my depression, but she would occasionally send me a funny meme or a smiley face with no context and no expectation of a conversation. Knowing that somebody was thinking of me was a solid reminder that I was a real human being worthy of love and life.
Be patient. Episodes do not last forever. We will always come around and become a pillar of support to you once again. But while we’re treading water, chuck us the fecking lifeline fergodssake.
Join the conversation. Follow online groups like University of Cape Town’s (UCT) Mad Hatter’s Society Facebook page to keep up with informative articles about mental illness. The only way to destigmatise mental illness is to create a widespread understanding of it. Be a mate and educate.
* A caveat: it is very painful to share the intimate details of my battles with mental illness, and this audience has, frankly, been spared the more gruesome parts of that story. I have to remind friends and family of the mentally ill that it takes a lot more time than you’d expect for everything to settle to some semblance of stability. We are not easy people to deal with: we can be selfish, spiteful and hurtful. We are sick. We need as much love and support as you can afford us. We do not always handle our lot in life with graciousness and a sense of humour. In fact, mental illness is not a laughing matter in the slightest. But, I figure if I’m going to bounce unconscious down a mountain after being up all night hissing menacingly at a stick outside my bedroom window, somebody might as well get a laugh out of it.