[we’re all mad here] on the other side of now

It’s August 2014, and as I write, for the first time in my life my mental illnesses are countable as being in remission.

I’ve more or less abandoned this blog of late. It’s a shame, and I shouldn’t have, but the girl who wrote the other [we’re all mad here] entries feels like a different person. I don’t recognise her voice. I remember writing them, but six months out of the trenches and I feel like I’ve left her behind.

The past is a foreign country.

I’ve mentioned a few times, to the friends who’ve only known me as being well, that for the last five years or so I’ve felt like half a person. Clearing out my old folders last night – preparing to move cities for uni – I was struck by a powerful sadness at all the things I’ve missed; all the things I half-remember. I was so absent from my life. The first half of my twenties more or less disappeared into the fog, and the people I’ve loved and lost only got parts of me. I was so unaware of how ill I was. I was so unaware that it was even possible to live differently.

I’m not kidding myself that I am free and easy in the land of the mentally healthy. Not until recently have I dared to describe this as remission, and as for the other r-word – recovered – you won’t find me saying it any time soon. That would be invoking the Wrath of the Whatever from High Atop the Thing. It will come back. I know it will. I just feel like now, I know it can be different. I can let it wash over me, but I know that it need not necessarily consume me. For the first time I understand that the power struggle does not have to end with my concession.

It’s been awful. But I’m here. I’m alive. I’m enjoying people. I’m nervous, excited, but not petrified about starting another degree, and I’m attached enough to my life and my friends that moving is bittersweet. I need to stop starting stories with the phrase ‘so that was after my mental breakdown – well, one of them…’ – but on the other hand, it’s my history and I’ll keep talking because openness is the only way to show that it’s not shameful. Painful and at times, embarassing, but not shameful. Just one part of who I am.

Thanks-Offering for Recovery, by Robert Lowell

The airy, going house grows small
tonight, and soft enough to be crumpled up
like a handkerchief in my hand.
Here with you by this hotbed of coals,
I am the homme sensuel, free
to turn my back on the lamp, and work.
Something has been taken off,
a wooden winter shadow –
goodbye nothing. I give thanks, thanks –
thanks too for this small
Brazilian ex voto, this primitive head
sent me across the Atlantic by my friend…
a corkweight thing,
to be offered Deo gratias in church
on recovering from head-injury or migraine –
now mercifully delivered in my hands,
though shelved awhile unnoticing and unnoticed.
Free of the unshakeable terror that made me write…
I pick it up, a head holy and unholy,
tonsured or damaged,
with gross black charcoaled brows and stern eyes
frowning as if they had seen the splendor
times past counting… unspoiled,
solemn as a child is serious –
light balsa wood, the color of my skin.
It is all childcraft, especially
its shallow, chiseled ears,
crudely healed scars lumped out
to listen to itself, perhaps, not knowing
it was made to be given up.
Goodbye nothing, Blockhead,
I would take you to church,
if any church would take you…
This winter, I thought
I was created to be given away.

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[we’re all mad here] keep on keeping on

I write a lot about mental health. I do so for a few reasons: the ever-prescient advice to write what you know; the fact that I’m declared generally unfit for the real world by virtue of illness; sometimes, a feeling that there’s a dearth of information on a particular topic.

But mostly, I write about mental health because I don’t have a lot of it.

I’m chronically mentally ill. I’ve been in treatment for depression for six? seven? years, and experiencing symptoms for a long time before that. I deal with levels of anxiety that are only offset by a carthorse-stunning amount of anxiolytics. I’m on my third species of antidepressant – not third brand, third type of drug. I’ve been therapied into the middle of next week and back.

And I still operate at only about two-thirds of ‘normal’ functionality on a good day.

I write about mental health and mental illness because they take up a lot of my thoughts. My own, clearly: but also my friends’, my role models’, the people in the books I read, the PhD I someday want.

I write about mental illness because I just can’t relate to a lot of the dominant discourse in mental health writing.

For example: I don’t believe that a so-far treatment-resistant set of problems dooms me for life, but nor do I believe that I can snap out of it or work it off with exercise and vitamins.

I can’t relate to the unbearably trite ‘sunshine and showers’ metaphor. There are lots of people for whom depressive episodes come and go a few times in a year, and I can see the value of comparing it to April showers if that’s your experience of your illness. Mine feels like a wet month’s holiday in North Wales, personally. Drizzly. Grey. A neverending trickle of rainy annoyance down the neck of your coat.

I can’t relate to the advice to ‘talk about it’ or ‘start an art journal’ because yes, thank you, I’ve thought of that by now. Lots. After a while you bore yourself and you bore everybody else too. Starting out on the path to recovery from a first, or a first diagnosed, episode of mental illness? Talk about it all you want. Write awful poetry and rip it up and enjoy the catharsis and my god, paint or shout or whatever you need to to get yourself past that first awful hurdle. It’s just that after years, depression doesn’t feel like something you can exorcise from your system. It feels like turning up at a dead-end job.

So maybe, the real reason I write so much about mental illness is this: there isn’t much of a voice for people who’ve long since accepted mental illness as part of our lives. Creating awareness, and offering avenues and outlets to people who need help for the first time, is so important, and it’s probably right that most of the media around these Awareness Days focuses on that. Articles aimed at removing the stigma of mental illness, actions taken to open people’s minds to the possibility that their friends and family may be suffering and may need help – wonderful. Seriously. I’ve written a few.

It’s just that there’s a lot of us around for whom awareness is unavoidable.

So here we are. It’s World Mental Health Day. It’s not just for people who’ve never navigated the choppy waters of seeking therapeutic help before. Rather, it should give the rest of us a kick in the backside to remember to ask for help when we need it, and to try lift ourselves from a routine-shaped rut, and to keep looking outward. Someday we’ll be able to look back at this and laugh.

(And someday, I’ll be able to look back on my Eeyore-like blogposts and laugh, too.)

[we’re all mad here] are you nuts, or something?

A couple of months ago I tweeted about having been waiting, somewhat impatiently, in a psychiatrist’s office, most of the morning. I wasn’t expecting a response aside from ‘doctors, eh?’ sympathetic irritation. It’s not like I keep it a particular secret that I have mental health difficulties. I often find myself having to self-censor to avoid annoying the bejesus out of my Twitter followers on a bad night – the temptation to fire 140 characters of misery into the ether is great, and mopey tweets are the gateway to mopey blogposts, and after that, I may as well give up and become a one-woman misery machine.

Checking my replies later on, I was shocked/amused/a bit of both to find one that just said ‘psychiatrist? are you nuts or something?’

And I cracked up laughing, first, and then sent a serious reply that perhaps the tweeter might want to refrain from calling psych patients ‘nuts’… and then resumed laughing.

Am I nuts, or something? Well, a bit of both, I suppose.

It’s hard not to feel a bit stereotypically nuts on a day like today, when I’m writing through a meds-induced fog and having trouble remembering synonyms for most words. Mind you, it’s better than yesterday, which I spent alternately asleep and wishing I was asleep, because wakefulness was hurting too much to be kept up for too long.

Right now I’m trying to work myself up to go for a run, but I’m afraid I might lose my way. On a treadmill.

I am lucky enough to have friends who understand all this, who’ve been there themselves or been around me long enough to understand that this sort of decreased functioning comes and goes by the day. That depressive episodes happen, but that they end eventually. That sometimes I cancel plans because I’m feeling too agoraphobic to leave my room. That, if they’re reading this, they’ll forgive the dreadful writing.

Part and parcel of that familiarity is that we speak about mental illness among ourselves in a way that would seem very irreverent, even ableist, to an outside onlooker. Sorry, having a crazy day. Are you having a BPD moment? The brainbats are acting up. Can’t go out right now, too much Outside already today. It’s not my fault I’m mentally interesting. Did you take your meds today?

Like most minority groups, those of us with mental health issues reclaim the words that in other circumstances would be insulting or dismissive (coming from outsiders) and add them to our own vernacular. Not everyone, of course: some of those who’ve experienced discrimination will always associate the slang around mental illness with bullying and fear, and that is both a very understandable and a very sensitive matter.

In first-year torts class we learned about the eggshell-skull plaintiff.  The legal definition isn’t particularly relevant here, so, in real-world terms: if you do something negligent, like dig a massive hole without putting up a warning sign, or fail to secure a heavy sign on your property, you are liable to be sued if your negligence causes somebody else harm. However, you don’t get to say ‘well, a grown man wouldn’t have been injured by the sign that fell on the little old lady, therefore I shouldn’t have to pay her compensation.’ If Mrs Murphy in all her frailty is the one injured by your negligence, then you’re liable for whatever injuries she has. Poor Mrs Murphy.

I’m sure you can see where I’m going with this. When you’re talking about mental illness, you never know who’s going to hear your words, or what state of mind they’ll be in on the day. Something that on a good day wouldn’t hurt me (haha, yes, I am a bit nuts) could, on a bad day turn in to ‘I’m not nuts, I’m ILL, and it’s RUINING MY LIFE’ followed by a certain amount of invective about the goddamn internet. Unless you know the person very well, you just can’t tell what sort of day it is, or what amount of mental resilience they’ve got.

So, summing up:

– Good friends who understand you are like hen’s teeth. Rare, amazing, and just a bit weird.

– In the case of H. Dumpty v R, the liability would fall entirely on All the King’s Men, and the egg would make bank in compensation.

– Don’t ask strangers on the internet if they’re nuts. Please.

[we’re all mad here] but suicides have a special language

(Before reading this, please be informed that I am not a doctor or a psychiatric professional of any kind. I speak from my own experience of many years of mental illness only. Nothing you read on the internet should take the place of a doctor’s advice.)

World Suicide Prevention Day.

There’s something nearly comical about seeing campaigns to raise awareness of suicide, when you’re living in the land of the chronically mentally ill. I would very much like not to be aware of suicide. I would very much like if several of my close friends had not felt – do not feel – they should have a go at ending their lives. I would very much like if I didn’t feel that way myself on more occasions than can be any way healthy.

The World Health Organisation says that 3000 people end their lives every day. From this viewpoint, all you can think is please don’t let my loved ones be among them. Please don’t let me be.

I feel selfish writing this, but I don’t have any other way to consider it. I think the goals of WSPD are laudable. I think there’s a lot to be done to improve mental health services everywhere – and I’m in an EU country, a developed country, so I can only imagine how much work there’s to be done elsewhere in the world. I think measures to reduce suicide by pesticides in still-developing countries are a good step forward. I think that opening a dialogue about mental illness with young people in schools is utterly vital in reducing the stigma that still surrounds having mental health issues.

But ultimately, I come back to how Anne Sexton described suicidality:

But suicides have a special language.
Like carpenters they want to know which tools.
They never ask why build.
Wanting to die is a lonely walk out on to a dark promontory. All the goodwill and best wishes in the world cannot stop the relentless drive in your unbalanced brain. In the end it’s a fight that takes place entirely in your mind, that ends up written on your body in scars or vomit or bruises. It’s a place that, once visited, haunts the back of your mind for a long time.
Kay Redfield Jamison, the celebrated mental health author who herself attempted suicide due to bipolar disorder, wrote, “When people are suicidal, their thinking is paralyzed, their options appear spare or nonexistent, their mood is despairing, and hopelessness permeates their entire mental domain. The future cannot be separated from the present, and the present is painful beyond solace. ‘This is my last experiment,’ wrote a young chemist in his suicide note. ‘If there is any eternal torment worse than mine I’ll have to be shown.'”
Awareness is good. Don’t get me wrong, awareness is good, but only if it’s accompanied by active work on mental health infrastructure. Blithely chirping that one should stay strong! and tell me all about it! may make the speaker feel better, but is unlikely to do a huge amount for someone already in the dreadful grip of hopeless despair.
I compare it to cancer awareness, often: everybody knows cancer exists, but not everybody has access to a doctor, or knowledge of how to check their body for odd lumps. Those are the things that need work.
At the very basic level, there’s no point passing on a Facebook status or joining To Write Love On Her Arms (and don’t even get me started on that rubbish) unless you know what to do if a friend does turn to you and say ‘I want to hurt myself, I’m scared, please help’. So, with a certain amount of experience behind it, here’s what I’ve found helpful:
  • if your friend is in immediate danger (has taken an overdose, opened a wrist, etc), you need to get them to medical help. Call 999 if necessary.
  • if it sounds like your friend is about to be in immediate danger, ditto. Get them to an emergency room. If they already have a doctor, especially a psychiatrist, call that doctor’s office and alert them.
  • if you’re far away, for example, an internet friend: try to reach anyone you know to be near your friend. A partner, a local friend, a family member, their doctor. Someone who’ll be able to get them to a hospital or sit with them until they feel less in danger of hurting themselves.
  • if you’re with the person and they’re not in immediate physical danger, follow their lead when it comes to interaction. Get them sitting somewhere safe, remove dangerous things from the vicinity, make them a cup of tea, and just be with them. Let them talk if they need to, but don’t push it. Sometimes the best company is someone who knows you well enough not to make you talk.
  • if you’re far away, but the person isn’t in immediate physical danger, do the same as best you can. Keep them on the phone or on IM/email, don’t force them to talk, but let them know they’re not alone. If you think they’ll respond well, encourage them to call a local friend or family member to come over.
  • your main objective here is harm reduction. It’s very hard to make a suicidal mind un-suicidal through conversation alone, but it’s possible to help someone calm down enough to stay out of immediate danger until they can reach professional help. If they’ve already hurt themselves, your objective is to get them to medical help ASAP. Harm reduction. You might not be able to achieve complete harm prevention, but you can stop things getting a whole lot worse.

Dear suicidal friends, brothers, and sisters: there’s lots of us. More than any of us know. There’s help available, even if you’re scared. If it comes to it – show this blog to the person to whom you’re relating your woes, and it might help them to understand. And as Bob Dylan said, keep on keeping on.

Once you’ve reached the lowest point, it’s got to get better.
For the simple reason that it couldn’t very well get worse.
Recommended reading:
Kay Redfield Jamison – Night Falls Fast: Understanding Suicide (seminal and unparalleled work on suicide and the suicidal mind)
Susan Rose Blauner – How I Stayed Alive When My Brain Was Trying To Kill Me (slightly fluffy for my taste, but worth the look)
Andrew Solomon – The Noonday Demon (excellent work on depression, including suicidality as a result of MDD)

with a little help from my friends

I recently came across an essay in which author Ann Patchett beautifully sums up the crux of what I hope will emerge in the final months of this search. “[Here’s] my idea of real intimacy,” she writes. “It’s not the person who calls to say, ‘I’m having an affair’; it’s the friend who calls to say, ‘Why do I have four jars of pickles in my refrigerator?'”. I want someone with whom I can talk about the deep stuff – hopes and dreams and expectations and disappointments – and also the minutiae. Sometimes it takes talking about everything to get to the place where we can talk about nothing.

– Rachel Bertsche, MWF Seeking BFF.

The above quote comes from the book I’m reading at the minute (well, yes, one of the books I’m reading). The author, having found herself living in Chicago with a lovely husband and a good job, feels like something is missing from her days. She realises that the absence she’s feeling is that of her two best friends, both of whom are still living in New York. So she sets herself a mission: make one date with one new potential friend a week, from people in her cookery class, to readers of her blog, to the partners and friends of those already in her social circle.

I have to admit that a huge part of my reaction to this project is the same one I’d have to someone announcing that they were about to take up tightrope walking above alligator-strewn rivers. Very nice, I’m sure, if you’re into it, but I’d rather chew off my own right arm. Forced socialising is something I deal with as occasionally as possible, with a finish line always in mind and a get-out-free card in my pocket. Textbook introvert, in other words.

At one point, Bertsche interviews John Cacioppo, a professor of psychology at the University of Chicago, and author of Loneliness (a book with a rather self-explanatory title). The Professor points out that while loneliness and depression are often seen as co-existing states, they are emotions which exert opposite forces on our social behaviour. Loneliness makes us pro-active – it is a force like hunger or tiredness, which alerts us to something necessary but missing. Depression makes us apathetic; we are aware that something is wrong, but we lack the energy and the mental space to fix the problem.

That last paragraph hits me uncomfortably close to home. Currently, I live in my hometown, with my parents. I lived in Dublin for five years, and Dublin is still where almost all my Irish friends are located. Many of us from this area flew the coop as quickly as we could: this is not a town with bountiful recreation or employment possibilities. I wouldn’t be back here if it wasn’t for the need to work on my mental health. My family are grand, but it’s not hard to come to the conclusion that I am now not only depressed – I am also lonely.

That feels odd to admit. I am perfectly comfortable discussing mental illness, trading stories of ‘once I was so agoraphobic I…’, and empathising with others with similar problems. Admitting to loneliness feels like a different kettle of fish. Perhaps it comes from the distinction we draw between illness, which hits us whether we want it to or not, and emotion, which feels like something we should be able to control.

John Cacioppo says “people who get stuck in loneliness have not done anything wrong. None of us is immune to feelings of isolation, any more than we are immune to feelings of hunger or physical pain.” And he’s the expert, after all. But there’s still a lurking feeling of being the last kid left while picking teams when one finds oneself checking Facebook and wondering if everyone else is out having fun.

That’s the problem, of course, with having online or long-distance friendships – while there’s no trouble narrowing the emotional distance between yourself and the people you encounter, the geographical distance is an uncompromising barrier. It’s a fun train of thought, when I ponder that I could go from New Zealand to New Mexico, up to Toronto and back to Tampere, and never run out of a place to stay or a local to show me the sights. Sadly, that’s not much good on a Saturday night when I’d quite like someone to help me with a tub of ice-cream and a stack of stand-up DVDs.

The rising mobility of young Irish people is also a factor, especially in the years since the economic downturn. My boyfriend lives over an hour away. My best friend is studying in Edinburgh, and our other close friend is writing software in San Francisco. My boyfriend’s friends, in turn, are looking at Australia, Canada, different parts of the US. Suddenly, not only are we looking at one part of our social circle having an international flavour, but the until-recently stable, home-based half is flying the coop as well.

To compound it, I’m also dropping in and out of a tentative attempt at a social life as the depressive and/or anxious episodes come and go. There’s the rub, then: loneliness may spur you to try to reconnect with society, but mental illness slows you down and tells you not to bother. Loneliness makes you step out of your comfort zone; mental illness calls you a fool for ever trying.

So the internet works, in that sense. Without having to leave the safety of my room, I can exchange quips about our favourite band with Sara in Toronto, read a poem by Delilah in London, and wish Claire in Auckland good luck on her holidays. It doesn’t matter if I’m having a bad brain day, if Kirsty wants someone with whom to marvel at the attractiveness of Cillian Murphy or Lizzie is excited about her upcoming PhD course, I can take part in the conversations at my own speed or, let’s face it, cognitive level of the given moment. The internet is a wonderful breeding ground for those four-jars-of-pickles friendships, as well as the more in-depth ones. It gives us a chance at intimacy with people that otherwise, we would never have met.

I just wish the internet could also pop around for a cup of tea.

[we’re all mad here] i see a darkness

This post is was meant to be written on World Mental Health Day, the 10th of October, or four days ago now. It’s a post that’s been somewhat recursively delayed. I want to write about mental health, but I find it hard to write because I’m too anxious, which makes me feel like I shouldn’t be writing, which makes me more anxious…

Because I am not  a Mental Health Blogger, but I am a mentally ill blogger. I suffer from simultaneous major depression and generalised anxiety disorder. I can’t remember a period in my life before anxiety, before fatigue and isolation and perfectionism and all the other fun side-effects of these disorders – and that’s before I even think about the medications.

In the past I’ve thought about writing a journal of my life in (and out of) mental health, but on more thorough reflection I abandoned that idea for one main reason: being mentally ill is really boring. I get up, I wish I hadn’t; I eat meals, I wish I didn’t have to; I start projects and abandon them halfway through; I leave the house only when I have to; I sabotage my own life over and over and I sit here and watch it happen – and I’m one of the lucky ones.

At least I have access to a psychiatrist, and to the medications that keep me somewhat functional. I have a brilliant counsellor, who’s been obstinately trying to convince me that I’m not the dire failure I feel, for the past three years now. I have a partner of four years, who hasn’t yet reached the point of throwing up his hands and heading for Australia. I don’t have a very wide social circle any more, but the friends I do have are amazing people without whom I couldn’t have gotten this far. I have a family who, although they may not understand everything I go through, have always tried to help me out, and educators who have been incredibly supportive. Lastly, of course, I have the internet, which is everything from the deepest of educational resources to a 3am therapist to a supportive international web of friendships.

I’m getting through this. I don’t feel like I’m getting better, yet, but I’m getting through. Thousands don’t.

According to Aware, over 400,000 people in Ireland experience depression at any one time. There are roughly four hundred deaths from suicide every year (in a country of less than five million people). 11000 visits to Irish emergency departments each year are caused by self-harm. This country is too small to see numbers that large.

If you suffer from mental illness, please know: there is someone out there who will take you seriously. There are people who will listen. Even if it is – as it was for me – only names and words on a blogging site, you are not the only person who has experienced pain like yours. You are not the only one who is down this hole. There are hundreds of us, and we’re all fumbling around in the dark without a map. Every so often someone will happen on a rope ladder and work their way out, and the rest of us are left to wonder however they managed it, to bitch a bit, and then to get back to the business of living.

And my next step is not backing out of making this post.

(PS: Mental Health Ireland has a campaign called Building Resilience for this week, which has tips from ‘have the courage to be imperfect’ (helpful) to ‘laugh out loud every day’ (teeth-grittedly aspirational at best). Worth a look.)