[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] reading material

Yesterday I read Brain on Fire: My Month of Madness by Susannah Cahalan, which is an excellent book and thoroughly recommended. It got me thinking about my predilection for psychiatric memoirs (despite not, in the end, being a psychiatric case history at all – but spoilers, sweetie).

I read a lot of first-person abnormal-psych accounts, and I think I have maybe three main reasons for it.

Firstly, somewhat obviously, in search of kinship. Often when you get several people with mental health problems together, we tell war stories. Therapy courses, hospital stories, destructive behaviours: talking it out is both entertaining and reassuring. Despite feeling very alone in my head, I find it helpful to know that I’m never alone in my illness. When I don’t feel able for friends and sociability, books are always there and they are undemanding in a way that no conversation, even between the closest friends, can be.

Secondly, I find the phenomenon of self-reportage entirely fascinating. You and I may be united under good old 296.30, but your experience could be totally unlike mine. No two depressions are the same; no two depressives are the same. A good writer can convey the destruction involved in the tornado of a depressive episode, but a skilled writer on mental illness can also discuss how their behaviours relate to the diagnostic criteria and how their illness manifests itself.

The need for a bit of inspiration at times is my final reason: it’s good to know you can succeed even with chronic mental illness as your personal albatross. Kay Redfield Jamison is one of my favourite authors. She’s written some of the best mental health writing I’ve ever read – Touched With Fire, on bipolar disorder and creativity, and Night Falls Fast on suicide. She’s a professor and an honourary fellow at several universities, and she’s dealt with bipolar disorder type 1 since she was younger than I am now. Her personal memoir, An Unquiet Mind, shows her to be an amazing lady who’s evolved her own methods of dealing with and fighting her illness.

Oddly, I don’t read an awful lot of depression memoirs. I would probably read more anxiety-related books if there were many (I cried my way through The Woman Who Thought Too Much by Joanne Limburg because she describes the horrible thought-spiral of anxiety disorders better than anything I’d ever seen). Depression, though, seems to cut too close to home. I find stories ending in ‘and I’m fine now!’ trite – and I’m entirely aware that that judgement comes from a keenly felt envy of anyone whose depression cleared up and went away after one or more major episodes, while mine drags on in a horrible dysthymic* malaise that feels like it’s going to last forever. Good writing about depression is a gut-punch to one who knows the state. For instance: I’m currently reading Darkness Visible, by William Styron, and this early section floored me in its stark truth:

The most honest authorities face up squarely to the fact that serious depression is not readily treatable. Unlike, let us say, diabetes, where immediate measures taken to rearrange the body’s adaptation to glucose can dramatically reverse a dangerous process and bring it under control, depression in its major stages possesses no quickly available remedy: failure of alleviation is one of the most distressing factors of the disorder as it reveals itself to the victim, and one that helps situate it squarely in the category of grave diseases.

Sing unto me a new song, Bill, for I fear I know all the bloody words to this one already.

* Dysthymia: a chronic depressive state, often described as ‘low-grade’. Sometimes it’s described as being like a cold as compared to the flu (a major depressive episode). This is rubbish. Dysthymia is to major depression (and cyclothymia to bipolar disorder) what a grindstone is to an avalanche: its nature is insidious and lasting, not sudden and violent, but eventually it wears you away.

[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] on slightly reneging on a promise

I currently have the following drafts on here: ‘James Onen at SITP’, ‘Fernando Blasco @ Alchemist’s Cafe’, ‘Murderous Mathsweek’, and a couple of other nebulous semi-ideas that may see the light of day. Eventually.

Probably not today.

I know I said I didn’t want to talk about mental illness all the time on here, and I won’t, but I would like to say one thing. On behalf of the above, and all the other projects lying around my hard drive and my brain that will never get started/finished/out into the world: if depression had a corporeal form, I would find it and punch it until I ran out of arms.

And now, if you’ll excuse me, I have some drinking tea and sniffling to be doing.