Change the Discussion (An OCPD, Anxiety-Laden Take on Mental Health)

*Stream-of-consciousness*

Imagine you and I are in a swimming pool. We are good friends and you trust me with your life – I would never do anything to harm you physically. Now, we are going to do a sort of experiment. You submerge entirely after taking a deep breath and I will gently place my hand on your head. Before you run out of oxygen I promise to let you out of the water and you will surface unharmed. There is no danger here. You submerge and feel my hand rest on your head.

Several seconds pass. The world beneath the water is quiet and calm, my hand feels almost reassuring. A slight pressure starts to build in your chest and you know this is longer than you typically go without breathing, but things are still fine.

A few more seconds tick off the clock and now your chest aches. You decide to surface and find my hand holding firm. Obviously, I am going to let you up before you drown or pass out, but not quite yet.

Now, for all your trust and confidence in the situation, panic starts to grip you. It creeped in slowly, subtly at first but is now screaming in your head. Various “what if” questions begin to cross your mind, like “What if he doesn’t release me in time?” or “What if he doesn’t know how long I can hold my breath?” Muscles in your arms and legs tighten, the aching in your chest worsens, and you desperately want to take a breath but it’s impossible.

But you are in no danger, and a moment later I help you surface. You gasp to regain your air and regulate breathing again, the aching in your body starting to subside.

That is anxiety. That is what millions of people live with every day.

My worst episode occurred at the end of my honeymoon. A full week in Whistler, British Columbia with my new wife enjoying the mountains and some winter activities that were no longer available to us having moved to Florida, and just before Christmas when decorations would adorn everything – perfection.

Still, we would be doing physical activities at altitude and in potentially hazardous cold weather. My concern was not the exertion, altitude, or cold, but how my anxious mind would handle those conditions. “Do not ruin the honeymoon,” I repeated as a mantra in the weeks leading up to the trip. All throughout the week, I would retreat inwards and breathe, consciously maintaining a level of calm. I survived the trip with only a few mild scares. The trip was over and we boarded an early morning shuttle to the Vancouver airport to head home.

I stepped off the shuttle and my right leg felt weak. Probably asleep from the long drive, I assumed. A few steps further into the airport to print boarding passes – now my leg felt incapable of supporting me. My breathing felt laboured and my vision seemed almost fuzzy (though when I looked directly at objects they remained clear). Over to the ticket counter to check our bags and now I cannot stand. I crouch down beside the counter while my wife checks the luggage. I gather myself up and head towards security where now I cannot breathe. A few minutes sitting on a bench provides no relief, and I know every passenger and every security in the airport sees something wrong with me. “They will never let me into the airport like this. We will not get home to the United States. Nothing is medically wrong with me – I know that, and yet I cannot breathe and can barely walk. The airport staff thinks you are pathetic. The other travellers think you are pathetic. Your wife is going to think you are pathetic.”

Steps away from passing through the final customs check, just one more official waiting to take our form, and we are in the terminal waiting for our flight. I drop to a knee and begin to cry, hyperventilating more and more as I try to slow my breathing. My hands tremble viciously and my head is at its lightest yet, though not quite to the point of fainting yet. Do I want medical assistance? What a stupid question – they cannot do anything for this because there is nothing medically wrong. I am being pathetic. My wife and the customs officer escort me somewhere for privacy and the EMTs arrive. A short while later I am sitting in a Vancouver hospital for monitoring as I slowly come down off the attack. The airline has already handled all our travel arrangements, the hospital staff are being incredible, and my understanding wife calmly makes a hotel reservation for the night.

For the next several months, I find myself unable to be near people. Every crowd or line I encounter immediately initiates a new wave of anxiety and every time I know I am fine. “This is the anxiety and it lies to you”, I remind myself. I focus on breathing and relaxing muscles that have tensed. I get through the day, but I increasingly attempt to avoid situations where that might occur altogether.

What I am discussing here is anxiety, which in my case takes several forms. I have generalised anxiety disorder, but also a smattering of specific triggers for anxiety as well and they relate to a separate personality disorder – obsessive-compulsive personality disorder. But what I am discussing applies to the entire spectrum of mental health and we as a society need to do a better job with those discussions.

The first issue is tackling the stigmas associated with mental health. The mere mention of mental health is enough to conjure images of someone chewing on their shoe and hearing voices. People are sometimes uncertain of how to handle me when I admit to my mental health issues, and mine are on the more socially acceptable end of the spectrum. How is a schizophrenic supposed to function in society if people automatically assume they are a danger? Spoiler alert – they are not. In fact, most people with mental health issues have an aversion to violence and are far more likely to be the victims of it than the perpetrators.

That comes back to the conversations we have about mental health. I could write an entire treatise about this because mental health has considerable overlap with other subjects dear to me like gender equality. Men and women experience mental health stigmas the same in that they experience them differently – far too many people still believe this mental health nonsense is “all in one’s head”. Men should not show weakness just as they should not show emotion. Women are hysterical creatures by nature, so of course they have mental health issues. It’s nothing fumigating the vagina would not fix, right? We wind up living in a world where men commit suicide and women struggle with depression at disproportionate levels because neither receives proper treatment, and men cannot even discuss it. But, again, that politics of gender parity and mental health is a subject unto itself.

Let us here focus instead on the universal part of this – the lack of understanding that mental health is a medical problem. Mental health is not a separate field of medicine, but a subset under the umbrella of overall health. When we discuss mental health first as though it is some pseudo-science pursued by liberal arts students and second as though the conditions themselves are the mechanisation of weak minds, we cannot provide people with the assistance and support they need.

Mental health issues have various causes. In some cases, a chemical imbalance is the cause. The mind interprets surpluses or deficiencies of naturally occurring chemicals in the brain that manifest as physical symptoms. Likewise, other physical symptoms and diseases can cause this to occur, such as swelling occurring in the wrong place. It applies pressure like a computer programmer typing a key and the brain responds accordingly. Sometimes the problem is thinking itself, perpetuated through a cycle of positive enforcement where the brain begins to make (incorrect) associations with situations or things. My obsessive-compulsive personality disorder and the strong perfectionist streak that goes along with it, are what turned my “upset tummy, don’t want to go to school today” anxiety into full-blown “call the hospital” panic attacks.

That fundamental misunderstanding means that even the most well intentioned individuals do harm. During many a panic attack I have had people say, “Just relax”, as though that was some option I had not yet considered. Colleagues comment on how calm, cool, and confident I present myself in meetings, though I have expressly told them that I am an absolutely wreck internally. I know how anxiety manifests itself and I know how to hide the symptoms so others do not see it. I am the picture of confidence because the obsessive-compulsive personality disorder in me literally studies the picture of confidence and then makes a conscious effort to portray that in meetings. Inside my mind screams, “Only another fifteen minutes in this meeting. Maybe use the bathroom as an excuse to step out for a minute. Oh God, I feel like I’m going to pass out”.

I see this all the time with depression, a disorder that I experienced briefly when I was younger. People look for depression with the same cognitive dissonance one looks for a drowning swimmer. We imagine someone splashing frantically and screaming for help, when in reality drowning is a quiet affair. The lungs fill with water and screaming becomes impossible. The only sign are arms grasping at the air and a fluid surface that refuses to offer support. Depressed people do not cry and make dramatic announcements. They suffer quietly and, in many cases, feel quite numb rather than sad. In fact, a number of comedians will admit to depression, the comedy being a coping mechanism.

Outside of specific episodes of certain mental health issues, such as panic attacks, one must also deal with the lingering lack of confidence. Anyone who has played sports and suffered some sort of physical injury will know the feeling all too well – a fractured ankle suffered early in the season and then the clean bill of health after recovery, but the ankle still feels tender. The impetus to project the wounded body part is strong. One might run slower and take turns more carefully until that confidence returns. This is the same with mental health. I may be anxiety free at the moment, but if I recently suffered an attack I am conscious of my mind’s fragile state. I avoid situations that might trigger a relapse even though I have no objective reason to think one will occur.

People do not decide to have mental health issues any more than one decides to have asthma, diabetes, or cancer. We do not condemn people for taking medications to manage medical conditions or for seeking out medical treatment in the first place. We do not criticise them for missing a day of work due to a flare up of their medical condition. People with mental health issues face constant criticism over medication use. And missing a day of work to manage a mental health disorder? Even if an employer is considerate enough to allow it, employees continue to face the persecution of managers and colleagues for failing to pull weight. Consider also that you might be supportive of colleagues taking said time off – remember that many of them face these feelings of persecution and do not necessarily trust that. Be open about your support for those people.

An even less popular opinion – make sure to extend this discussion to substance abuse. Society tends to view substance abuse as the fault of the abuser even more so than mental health issues, but addiction is a mental health issue. Addicts do not choose to use substances any more than a diabetic chooses to use insulin. The image that many have of people making poor life choices and then hiding behind illicit substances is a false narrative that does widespread damage. In some of the cases, the substance abuse is a means of self-medicating for a mental issue that never received proper attention, or even for self-medicating a physical condition where actual care is prohibitively expensive. Policing the substances themselves without offering adequate care for the addiction is a losing battle, for everyone.

As a parting thought, some readers may be wondering why it seems that so many more people have mental health problems today than ever before. Some people also wonder why sexual assault cases from forty years ago only now come up in discourse. The sudden increase has little to do with an actual increase in the number of cases and more to do with an increase in the number of reported cases. Society vilified mental health and substance abuse, making it impossible (or least making it feel impossible) for those suffering to come forward. Those who do come forward still experience stigmatisation and inadequate treatment because those who inadequately understand the issues make decisions about what treatment should look like.

Your family, friends, and colleagues have mental health issues, even if you are fortunate enough to be healthy. These are not weak people or poor decision-makers – they are people with a condition. Those conditions are manageable like a cold or the flu with the proper treatment, which currently lacks. If the concern is that our medical system cannot support the additional cost of expanding for these treatments, I promise society will make all that money back and more in the form of productivity that is currently lost, talent that is currently overlooked, potential that is unrealised, and medical treatments that are not necessary (like the countless anxiety attacks that result in emergency room visits).

To my fellow mental health readers, you are not going through it alone. I know you feel quite alone at times, but millions of others do understand what you are experiencing and are able to help. You waste no one’s time seeking treatment – if you are having a panic attack and feel you need to go to the emergency room, go. If you are thinking about hurting yourself or someone else, call one of the support lines. Never feel that you are burdening others with your problems and shy away from treatment.

Lastly, a piece of unsolicited advice – no one is confident. No one in life will achieve a rank greater than amateur as everyone does what comes natural, what makes the most sense at the time. We live in a constant state of change and learning. People mask their insecurities every day, but they exist. In fact, I have a theory (that I will share in detail later) that everything we do is a consequence of insecurity. That conflict is what motivates people to action. When you look at someone and think, “Wow, they really have it together”, remember that, no, they do not. They are going through a journey fraught with obstacles and uncertainty just as you are, and their insecurity manifests itself uniquely.

We all need compassion and understanding.

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