Trigger warning: Difficult mental health issues and suicide
Well, it’s October and my bipolar brain said “howzabout we take another ride on the depression train?!?” So here we are for a while until it passes as it always does. I decided to distract myself with writing for a while so I’m doing something other than staring at the wall and weeping. Apologies in advance if I ramble or rant. Future me might not have the energy to do proper editing. I’m also writing this from the perspective of bipolar and autism since that’s what I know. Other people will have different experiences and perspectives, so don’t take my examples as representative of everyone with a mental illness. Finally, I mention autism a couple of times even though I don’t consider it to be an illness (it’s a developmental disorder). It’s useful to include developmental disorders in this discussion since most of this applies equally to developmental disorders and disorders that are generally thought of as illnesses.
On to the real topic. There’s been a lot of progress in the past few years to raise awareness of mental illness, but we’re far from accepting people with mental illness in the same way that those with physical illnesses or disabilities are (or completely healthy people for that matter). Personally, no one knows that I’m bipolar beyond my immediate family and doctors. I don’t tell anyone even if I’m having obvious symptoms. I just don’t know who will judge me or how. How would being openly bipolar affect me professionally? I have no idea and it doesn’t feel safe to test that out if I can avoid it. I’m sure that everyone would say that there’s no shame in it and they don’t feel any different about me, but there’s still going to be an expectation that I not have any visible struggles with my illness. I’ve taken days off before because of migraine-induced vertigo with no problem, but I suspect that taking a day or two off because I’m too manic to focus on anything would be a different matter. I can take the days off, but I need some other plausible excuse to avoid being that guy who can’t keep his shit together. Being openly bipolar in social settings also comes with risk. Are people going to whisper behind my back? Will they view everything I do through the lens of mental illness? It’s hard to say. Even when people try to be accepting and avoid judging, biases remain and it’s hard to break through.
Based on polls from a few years ago, things have improved a lot compared to a decade ago, but dig into the details and it still doesn’t look so good. The top line being touted is that 87% of adults agree that mental illnesses are nothing to be ashamed of. That sounds great. But then we have 55% who feel that mental illnesses are different than serious physical illnesses. 39% say “I would view someone differently if I knew they had a mental health disorder.” 33% say that “people with mental health disorders scare me.” Here are the real kickers: 81% say they would be comfortable having a friend with a mental health disorder, but only 51% would consider dating someone with a mental health disorder and only 35% would be comfortable having a mentally ill person care for a child. In other words, we kind of like you, but don’t get too close and don’t expect us to rely on you to handle anything important. It’s kind of hard to believe that a mental illness is nothing to be ashamed of if revealing one cuts my dating pool in half and renders me unfit to be alone with children, whether I’m symptomatic or not.
One other number from the poll that I find concerning is that 63% believe that suicide is a selfish act. Of course we should do everything we can to prevent suicide and get people the help they need to get through depression, but we also need to start treating depression and some other disorders as life threatening illnesses, not conditions that could involve bad choices. That doesn’t mean that we should panic whenever someone gets depressed — we just need to recognize that getting to the point of suicide generally develops over time, just like any other deadly illness, and isn’t something that people can necessarily control. And we need to recognize that people who are suicidal usually don’t want to die. Not really. They want the unbearable pain to end and death seems like the only way out. It’s hard for anyone who hasn’t been there to understand how truly horrible it is. “Choosing” to take your life isn’t a choice like choosing chocolate or strawberry at the ice cream shop. With all of the pain, confusion and altered mental states that come along with severe depression, thoughts that would normally be completely outrageous can seem entirely rational. Sometimes people hold out for weeks or months and give in in a moment of exhaustion when impulses can no longer be controlled. So no, there isn’t anything selfish about dying from depression. Telling someone who’s struggling to live that dying is selfish isn’t what they need. Acknowledge that people struggling with suicidal thoughts are fighting for their lives, just like people with cancer, and be understanding about what they are going through.
So what would true acceptance look like? I don’t have a good answer to that and I don’t know how we can get from here to there. At a minimum, the numbers above have to improve. People like me need to feel safe about being open with our illnesses. Telling me there’s no shame is not the same as making sure I’m safe. I need to know that being open doesn’t come with a high price, that I won’t become a silent outcast because I’m the wrong kind of person. I need to be allowed to have my illness without spending all of my energy on hiding the symptoms to keep everyone else comfortable.
As I said, I really don’t have any good solutions, just some small steps that might help. One thing that can be done is to change the way we speak about mental illness. It’s pretty common for people to casually label fairly normal behaviors as mental illnesses: “I’m OCD about keeping my kitchen clean” or “I’m feeling a little bipolar lately” or “everyone is a little autistic.” No, no and no. Being excessively tidy is not OCD, you probably don’t know what bipolar actually feels like and a spectrum disorder doesn’t mean that everyone has it “a little bit.” Casual labeling like this just minimizes what actually ill people are going through. People with mental illness shouldn’t be described as “unstable” or “dramatic” either. Maybe that’s true sometimes, but it often isn’t.
Don’t challenge people’s diagnoses. As in “you don’t seem like you’re bipolar.” It’s hard to tell why people say stuff like that, but it comes off as either minimizing or questioning the diagnosis. In reality, it’s a sign that either the treatment is working, symptoms are not currently present, the person is good at hiding symptoms or you just aren’t that familiar with the condition to begin with. If someone tells you about their diagnosis and you’re surprised, maybe just ask them how they’re doing with it instead.
Don’t state that disorder X, Y or Z is over-diagnosed or a fad. Maybe it’s true, but people don’t want to be treated as imposters, as if they just got caught up in the disorder of the week. Chances are that if they got a diagnosis, something is wrong. Maybe they got the wrong diagnosis. Maybe they didn’t. But don’t brush it off as nothing. A lot of us second guess ourselves enough as it is. We don’t need the general public to pitch in on that front.
Don’t say that someone behaving erratically has “gone off their meds” unless they’ve said it first. It’s true that mentally ill people will sometimes abruptly stop medication without consulting their doctor, but there are other reasons that someone might relapse or have worse than usual symptoms despite being medicated. With bipolar, for example, medications don’t always stop episodes entirely. They reduce the frequency and/or severity, but it’s always going to happen from time to time. Medications also have to be actively managed. Getting and keeping the right combination and dosage can be a challenge. Sometimes medications that worked really well will stop working. And then there are a whole lot of mental illnesses that just can’t be treated with medication or people who don’t respond well to medication. Those people don’t deserve to be shamed as if they’re refusing any kind of treatment or self care.
On the subject of how we think and feel about mental illness, maybe a first step is to stop using the term and call those conditions brain disorders instead (I’ll continue with mental illness here for the sake of continuity). The “mental” in mental illness, I think, is one of the reasons that the majority of people think that mental illnesses are different than physical. I guess they’re different in the sense that no physical tests are available to give insight into a diagnosis, but other than that there’s a lot in common. For example, it’s easy to find physical illnesses that cause altered mental states (stroke, epilepsy). Some mental illnesses are treatable with medication and some aren’t. Both physical and mental illnesses can involve lifestyle changes as part of the treatment. Some sort of therapy may be used to compliment other treatments, or even as the primary treatment.
One of the reasons it’s important to start thinking of mental illness as having a physical basis is the expectation of self-control. With practice, I have learned to have more control over how I respond to symptoms, but I can’t will them out of existence and some features will remain no matter what. If I’m having a manic or mixed episode, I can resist the urge to snap at people and be extra mindful of impulsiveness, but I’m still going to be wild-eyed and edgy from all of the adrenaline that’s flooding my system. I might have tremors or be unable to sit still for long periods of time. I might have brain fog because of a depressed mood or lack of sleep. I can’t do anything about that. These are things going on physically with my body and brain and not some abstract mental state. The same is true of a lot of other mental illnesses — some are easier to control that others. Modifying responses to symptoms can also take a lot of time and effort to learn. Don’t automatically excuse bad behavior just because of an illness, but be patient with people who are making an effort and still learning.
Something that goes along with the expectation of self-control over symptoms is to just allow people to have symptoms and respect their need for self-care. How great would it be if I could just tell people that I might be a bit incoherent because of mania, or I can’t go to a particular restaurant because of the risk of sensory overload and have that limitation respected? Don’t hold it against someone if they need to suddenly remove themselves from a situation or ask for accommodation.
We need more first-person stories from people about their mental illnesses. This happens more frequently now for more common disorders like moderate depression or anxiety or even ADHD. But how often do we hear, in detail, what it’s like to have OCD or a mixed bipolar episode or be on the brink of suicide after months of severe depression? Or what it’s like to be autistic and have sensory overload? Those stories are out there if you search around, but most people don’t hear them and they rarely hear them from someone they know. This is a hard one because it just isn’t safe for a lot of people to talk about their experiences without remaining anonymous. I would never tell anyone about what was going through my mind when I attempted suicide at 19. It’s easy to say that I felt hopeless or without worth, but explaining what it really felt like is just too risky. I would probably start sobbing half way through and I also worry that people would just regard me as dramatic. A lot of these things are kind of dramatic, but not because I want them to be.
Stories also need to come from regular people, not just celebrities. Too often, celebrity accounts are treated as a public spectacle or romanticized. We’ve all seen Charlie Sheen waving his machete on the roof or heard the trope about madness spawning creativity, but what about the weeks of unwanted insomnia or inability to focus or the emotional fallout after doing something impulsive that hurt loved ones? We need reality, not spectacle, romance or tropes about the hero overcoming adversity. I’m not a hero or brave or broken. I’m just a guy working my way through life like everyone else. And I’m thankful that I have a dog who will love me and be at my side no matter what kind of day I’m having.
