I have covered this in prior entries, but to recap quickly I have lived with obsessive compulsive personality disorder and generalised anxiety disorder my entire life. I have had bouts with depression, panic disorder (both of which appear to be things of the past), and social anxiety disorder (which persists). For the uninitiated, these mean that I meet/met the diagnostic criteria for each of these conditions, which at its most critical point means that the symptoms of that respective illness interfered with my ability to function normally.
For a period, going anywhere felt like an impossibility. As I would speak with people, I could feel the air disappear from my lungs, my legs would feel weak, and my vision seemed to blur until I began to feel lightheaded. At its worst, those episodes would culminate in full panic over absolutely nothing.
Oh, and I have OCPD – not OCD. I know some readers will pick up “obsessive compulsive” and start to imagine me flicking the lights five times before entering or leaving a room. That is part of the problem – the pop culture version of mental illness. Schizophrenics are serial murderers waiting to happen and those with OCD have to futz with light switches.
The reality of mental illness is far more banal and, consequently, dangerous. I liken it to drowning. Pop culture would depict a person splashing wildly, screaming for help, and waving for help. The reality is that drowning occurs rather quietly. The person holds their breath as long as possible but invariably has to take one, bringing water into their lungs. The suffocation makes screaming impossible and one starts to lose consciousness – the hands instinctively reach for the surface but remain more or less still. It is slow, painful, and quite possibly invisible to those who do not recognise the signs.
Yes, to the casual observer I am exactly the man you want on your team. I have my life together – a picture of responsibility in many respects. I do tasks without prompting and often complete things well before deadlines. They are done to a degree of completeness that employers admire and colleagues envy. I speak confidently and assertively about my ideas. I look for others and make sure they feel heard. My colleagues regard me as confident, intelligent, and charismatic.
If that sounds discordant with the list of mental illnesses provided at the start of this entry, you aren’t alone. The state of mental healthcare in the United States and abroad clearly indicate a fundamental misunderstanding of the issues.
One hears OCPD and social anxiety and might immediately assume a quiet individual with a number of tics. On the contrary, I am plagued by concerns about failure and what others think of me. I am a perfectionist. I am rational to a fault in a world that often displays chaos, and I need to control what I can. I am self-righteous (those who haven’t read my other entries). Much of who am I is not despite my mental illness, it is because of it.
Therein we find another problem with mental illness – a tendency for those with severe issues to ingrain those issues into their very identity. If I were to wake up tomorrow completely free of my anxiety issues it would likely throw me into the depths of an existential crisis rather than provide relief. I know life without crippling anxiety, but I do not know life with anxiety at all. My perfectionism, my rationality, my practised charisma – these things, all products of my mental illness, are considerable strengths as well. If I could free myself of the burden of mental illness, would I also lose my strengths? We see this often in creative careers where things like anxiety, depression, and substance abuse become the catalysts for the creativity. The creator can come to fear leaving behind the creativity along with the illness.
The truth, for those of you reading this who may identify strongly with that, is that you have, at that point, developed a skill. Yes, your depression may have compelled your creativity, but you now know how to think creatively. Beating your depression will not ruin that.
You Are Mentally Ill
The fundamental misunderstanding referenced earlier is treating mental health as though it is some foreign field rather than as an aspect of physical health. We tend to view mental health in two extreme camps: normal and abnormal. A person is either mentally fit or struggling with a disorder, and that unfairly overlooks the gradient nature of mental health.
One does not regard one’s physical health as either fine or compromised. Obviously we have extremes where we feel our absolute best or stave off death one breath at a time. However, one also recognises all of the degrees in between. I feel healthy today, but my back aches a bit from sleeping awkwardly last night. All things being equal, I will let this go without medical intervention or rely on home remedies like acetaminophen and heat to improve the condition. If it persists, I will seek medical help.
Why then with mental health is the notion of medication or professional intervention such a stigma? Sure, I wake up feeling low affect one morning perhaps I do not rush off to see a psychologist. After a period though? I should certainly seek help sometime before I find myself standing on the side of a bridge, just as I should seek treatment for my back before paralysis occurs.
Our society still looks down on mental healthcare though. People with mental illnesses are weak. They have some defect, either inherently or through self pity, that makes them unworthy of care. Even if you are one of the supportive individuals who advocates mental healthcare and knows this is not true, those suffering do not know that you know. People who suffer feel the judgement of those who don’t with every breath. They need our support to bridge the gap of stigma.
But I digress. We are venturing too far into disorder territory, towards those whose mental illness is so severe that it adversely affects their quality of life. What about all of those with backaches though? Yes, I was at the point where the thought of going out into public was enough to trigger a panic attack, but long before that I had mild stomachaches. Time to head off for school? Stomachache. Time to go to practice after making a mistake in the last game? Stomachache.
Your mental health is on a spectrum just as your physical health is, and just like your physical health, illness and injury lie around every corner. My knee hurts at times because of years of sports – I wore away at it over time. My Achilles tendon was healthy until the day it tore. No warning. I was rollerblading as I had done a thousand times before. Even those with excellent mental health may find themselves in the throes of a disorder without warning. Life is funny that way.
What changes based on our genetics and environment is not so much the risk of mental or physical health issues, but which mental or physical health issues are most likely. Like physical health, mental health comes in a whole array of flavours. There is something for everyone.
Let us return to the OCPD example. I mentioned that who I am today reflects the presence of the OCPD, but OCPD is a disorder. Without the disorder (the adversely impacting my life part), I simply have an obsessive compulsive personality. That is who I am – full stop. My genetic makeup and life experiences made me that way, but it went unchecked and developed into a disorder that prevented me from living a healthy life.
How do I mean? Well, I can rattle off a list of other characteristics for you that fit me: white, heterosexual, cisgender male, brunet, American by birth, Irish and Italian by ancestry, raised Roman Catholic, atheist, logical, existentialist, right-handed, oldest child, tall, middle class, white collar, liberal, progressive, Hufflepuff…it goes on. My parents are still married and employed. They did a good job raising me, especially when I hear stories from others. My great grandparents also had a very close relationship. I have two younger brothers. My friendships are few but strong and long-term.
All of these things and my specific life experiences compile together to make me obsessive compulsive. I have empathy for others and want them to like me, but I want people to like me for what I accomplish, for my ability to support them. That drives my work ethic, makes me a perfectionist, makes me obsess about projects. Logic, because of its objectivity and reliability, serves my process, which makes me reject faith-based ideologies like religion but still defines a set of values and rules. Violation of those rules, especially by myself and especially when it oppresses someone else, frustrates me.
The point is that even in the absence of a condition we can diagnose, my mental health colours every aspect of who I am. It defines my fears and insecurities, and that in turn drives how I interact with the world around me. Conflict upsets me because it suggests the other person does not like me, so I learned to diffuse conflict with humour. That is not always healthy because at times I am deflecting conflict that needs to occur to maintain the relationship. I deflect and the conflict festers instead of resolves.
Every single person on this planet is the consequence of their mental health. Everything we like and everything we do is the result of attempting to fill a need, and the methods we choose to meet those needs are varying degrees of healthy. We eat because we hungry, because our brain and stomach (brain #2) are sending signals that we are hungry. We also eat to comfort ourselves in times of stress. Some people refuse to eat or display other eating disorders because, despite the hunger signal, they have an overriding signal concerned with appearance.
In that sense, no one has it together. Take comfort in that, friends. Everyone is doing their best to figure out how things work, and some do it better than others. Some are luckier than others. One can make crap decisions and come out fine, one can make all the right decisions and still get screwed over because the universe is objective and uncaring. Remember, that is not the wishful thinking of a nervous wreck – that is confirmation from the guy often regarded as the one who does have things together.
That is why the superstar, the global celebrity who achieved more than most people could ever dream to achieve, suddenly commits suicide or comes out to reveal mental health issues. Mental health discriminates as much as a sprained ankle or the flu discriminates. No amount of wealth or accomplishment can insulate a person from mental health issues. At best, it provides them with greater resources to combat the problem.
Many actors enjoy the process of being someone else. Some accountants like the security of the job – the profession is relatively safe and in demand. One does not encounter very many adventurers in the field. I love watching NHL hockey but I find the NBA boring, though many Americans would feel the precise opposite. Each of these things have qualities that speak to our particular brand of insecurity. We develop the skills we need to survive, and that changes depending on where we are in the hierarchy of needs. Those skills, in turn, dictate what we enjoy. We find applications for those skills. We find things that challenge those skills.
The point is not that you are wrong for being an accountant who likes the NBA. The point is that we need to acknowledge the daily role mental health plays in our lives and the precarious nature of it. It has the same precariousness as our physical health (hysteria – it can even spread in a similar epidemic nature). One can go from the picture of health to debilitated in a relatively short period. Unattended symptoms can evolve over time into serious concerns.
And like a diabetic taking insulin or an asthmatic with an inhaler, there is no harm in pursuing medical assistance – that includes pharmacological assistance if under the advisement and supervision of a medical professional. Medication is not a long-term solution, but it provides the symptom management necessary to recover one’s mental health through more natural means. If people were more open and proactive about addressing mental health, we could address many conditions before they get to that point.
Tens of thousands of Americans die every year because we lack this fundamental understanding of mental health – that it is an aspect of our physical health. It fluctuates over many degrees and can worsen suddenly. It does not discriminate. One does not self-inflict mental illness. And like mental health, no one is 100% healthy – certainly not all of the time. That part that lacks understanding of this universe is the part that colours who we are the most, and we should all be able to empathise with that part and show compassion towards mental healthcare.
I could not find a way to address this within the flow of the entry itself, but it warrants specific discussion. Substance abuse/addiction is a mental illness. One who lacks that addictive tendency can interact with addictive substances without developing an addiction; that is, to the point that one becomes chemically addicted. One who is only chemically addicted to a substance can come off the substance with relative ease. Psychological addiction is a disease, not a matter of poor life choices.
Like with mental health issues in general, the presence of a disorder does not absolve one of responsibility for what one does. Addicts destroy not only their lives but the lives of those around them, and I am not advocating that once someone has a diagnosis they have carte blanche to run roughshod through life. I am advocating that we treat them with compassion as individuals struggling with a disease rather than as cretins intent on wreaking havoc.
Part of that begins with better drug education. I know my drug education growing up was that drugs are bad. The truth, I learned in adulthood from watching friends go down that path, is that drugs are actually amazing. The begin with tremendous pleasure and little pain, but that balance shifts over time until eventually pleasure becomes impossible and only pain remains.
When we live in a society where so many people are already inclined towards addictive behaviour and we do a terrible job of offering mental health services, then try to scare them off something that objectively works to solve their problems in the short-term, we are going to have problems. Honest conversations about these topics would go much further towards helping people.