It’s Mental Illness Awareness Week. This year’s theme, promoted by the National Alliance on Mental Illness, is CureStigma: breaking down the shame, fear and silence that prevents many people from seeking help and treatment. The perception of mental illness won’t change unless we’re open about it.
So, here I am.
Mental illness isn’t as hush-hush or misunderstood as it was years ago, but it’s still tossed around like a personality quirk instead of a real disease. How many times have you heard someone say, “She must be off her meds!” about someone who’s acting upset? Or, “I’m so depressed!” when they have too much work to do or their favorite show ended? (Guilty.) Chances are the same person wouldn’t say, “She must be off her life-saving chemo!”
One in five Americans has a mental health condition, and I’m one of them. I have panic disorder. I’ve also been treated for OCD, although I don’t have the “classic” case: Most people picture someone who obsessively washes her hands or has to tap on a door three times before leaving the house. My fixation (or obsession) is health: worrying constantly about getting cancer, whether a harmless blemish was melanoma or whether a strange headache meant that I was harboring a brain tumor. My “compulsion” was research and reassurance: I’d Google it, prowl message boards and run to the doctor for validation. I’d be fine for a few days, or weeks, or even months, until the cycle started up again.
These days it comes and goes. I can go months at a clip without once checking myself for an imaginary tumor. Then a tragic GoFundMe page will crop up on my Facebook feed, and I’m suddenly plotting my own death.
I’ve dealt with it since college, and I’ve written and spoken about this stuff a lot—so if you’re reading this and want to reach out, please do it. I have no secrets. I get emails from random people almost every week telling me about their experiences, asking for advice and just needing to vent. I’m always hear to read and to listen. So feel free.
I have cognitive-behavioral tools to deal with it now, but there are also some personal, informal rules that I try to follow in my own life to keep things on track. Below are some of those rules that I’ve given people who email me. Requisite line: I am not a doctor, and this isn’t medical advice. This is based solely on my own experience. But it’s honest, and I hope it’s helpful. Remember: You’re really not alone. There are 43.8 million of us out there.
Don’t settle for a mediocre therapist. Finding a good therapist and a good prescribing psychiatrist, if you need one, is pretty much awful. It’s like dating, only with a copay and a two-month waiting list. It can take endless weeks or months, all while you’re feeling miserable and not particularly ambitious or organized, to unearth a competent person who is also affordable. And because it’s so hard to find a compatible therapist or psychiatrist, you might be tempted to stick it out with one who isn’t right for you just because he or she is available. Try not to do it. Don’t settle. Actually, let me modify: You might not have the best rapport with your psychiatrist. Hopefully you will, but if not, I think that’s OK. If they know their medications, you don’t really need him or her to understand your darkest fears and interpret your innermost thoughts. (And if you’re having a true medical crisis, you should go directly to the emergency room regardless.)
I’m talking about therapists, the people you see every week and with whom you discuss your destructive thought patterns and long-held hang-ups. This person has to understand you. I’ve had therapists with whom every new appointment felt like stiff cocktail-party chatter (“How are you?” “Good! How are you?” “Good! How are you!” “Why am I paying $120 an hour for this?”) or who blindly projected their techniques onto me without any regard for my personality (“I intuit that you long to share your feelings through crayons, expressive movement and pottery!”). If you don’t click after the first appointment, don’t assume it will miraculously improve. Look for someone you connect with right away. It will make so much difference.
Negotiate your payment plan. If you can’t afford your therapist or if your appointments aren’t covered or reimbursed by insurance, ask if they’ll offer a discount. Many do.
Get the hell off of social media, or at least edit your intake. Wrapping yourself in a virtual cocoon is so tempting when you’re marinating in your own mental sludge. You don’t need to interact with people or put on a happy show! You can gaze safely at life from the outside! The thing is, social media can also reinforce your otherness: the parties that you didn’t feel up for attending (or didn’t get invited to…is there something wrong with you? Can people tell that you’re having problems? Oh, no, is it obvious!?); the old roommate who seems so together and has probably never had an unpleasant thought in her life (likely untrue, but Instagram doesn’t know that); the long-lost friend who never gets in touch anymore for reasons unknown; whatever.
Social media has no context, no empathy and no compassion. If you’re already feeling horrible, it will make you feel even worse. You will begin to collect injustices and resentments; you will spiral down a kaleidoscopic wormhole of inadequacy where feelings and connections are distorted, hazy and unsettling. You might even see people who are also struggling with mental illness, posting about it and hash-tagging and trying to spread the word. Which is great, except when you can barely muster the energy to take a shower. Their activism might not inspire you; it might make you wonder how they can feel so crappy and still post so triumphantly. No, you do not need internet strangers right now. If you can’t completely disentangle yourself from social media, at least hide the people whose feeds make you feel like dirt. And then…
Make real human connections. This does not have to be high-maintenance. You do not need to force yourself to have dinner with a group or to pick up the phone (the dreaded phone!) to force yourself back into the swim of humanity when you’re facedown in the dip. You just need to anchor yourself on planet earth, whether that means going to the grocery store; making small talk with the cashier at CVS; going for a walk to pick up your kid at school. Maybe it’s the only thing you do that day. That’s OK. It’s immensely grounding to know that there’s a big, often reassuring world out there. In fact, sometimes these superficial transactions are often the best when you’re down: No need to tell the cashier that you’re adjusting to Zoloft and puked all morning or to tell your kid’s fourth-grade teacher that you had a panic attack at yoga. You can just smile, say hello and then retreat back to your nest. Keeping interactions light and positive builds on itself. Maybe the next day you can walk with someone. Start small, and set little goals. Maybe the biggest thing you do all day is take a shower. That’s a victory. Revel in it.
Have a lifeline. Designate a couple of people to turn to when you’re really feeling horrible, and actually ask if they can be your lifeline. This means that you can always say, “Hi. I’m having a bad day and feeling scared. Can we talk for a few minutes?” and they won’t be caught off-guard.
Treat yourself like an athlete in training. Dealing with mental health is exhausting. It’s not like having a broken leg, when there’s a prescribed course of treatment and a clear-cut plan: ice the leg, elevate it, get the cast off in six weeks. Instead, you’re creating that plan for your emotions, your brain, your soul, your well-being…and there are no set rules. So set yourself up for maximum success: Take a nap. Go to bed early if you need to. Say no to engagements that will tax your mental resources. Push yourself in small ways (walking to school, stopping at the grocery store) but be good to yourself in the big ones. Don’t do things that run you dry or make you upset. Avoid people who are too much work or who don’t give back. Be incredibly selfish until you feel like you can reengage in a more reciprocal way with the world. I’m not urging you to become a shut-in or to cut out everyone you know. But I am saying that you need to surround yourself in comfort and rest and compassion, and anything that doesn’t evoke that feeling for you can go directly into the trash for the time being. Or maybe forever! Mental health does wonders for helping you reevaluate your priorities and pinpoint things that you truly enjoy doing.
Be open, when you can. Transparency is an individual choice, but I’ve found that it really helped me so much. But it’s hard to be open: Mental health is far less stigmatized than ever before, which is wonderful, but it can also become a cloud that follows you around in social situations. People might want to know how you are when you don’t feel like telling them or treat you more gingerly (even unconsciously), even if you’re feeling great. So, know your audience.
Overall, I’ve found that it’s helpful to tell people that I deal with anxiety and panic because then I can offer up a clear rationale for certain behaviors: Hey, I can’t go to the party that starts at 10 p.m. because I really need eight hours of sleep to feel less anxious. Hey, I’m not drinking today because I had a panic attack recently, and alcohol sometimes makes me wake up at 3 a.m. wondering whether I have a tumor. Openness has also helped me connect with other people, because when I share, inevitably someone tells me that they have the exact same issue, or know someone who does, and it makes me feel so much less alone. It’s nice to know that you’re not as weird as you think you are. Really.
Drink mindfully. Ah, booze! The best anxiety-reducer ever, until you wake up the next morning seized with panic and a racing heart. When I’m feeling off my mental game, I sleep better and feel more even-keeled when I don’t drink. This isn’t to say that I never enjoy a crisp glass…or three…of white wine. Hardly. But if I’m already in a somewhat jittery state or feeling off-balance, I’ve learned that drinking alcohol is like splashing fuel onto a smoldering fire. So I check in with myself beforehand. If I’m traveling to an unfamiliar place, or about to get my period or coming off a stressful day of work, I’ll probably forgo white wine in favor of water. Ain’t no shame in it; it’s just like abstaining if you’re getting a sore throat or have a headache. And if people ask why you aren’t drinking (especially if you’re a woman of pregnancy age), I like the honest route, with various degrees of detail. If you don’t know the person that well, you can just say that you’re not feeling well or that it doesn’t agree with medication that you take. I usually say that sometimes drinking just messes with my equilibrium in a way that isn’t fun, and it depends on the day and on my mood. You’d be surprised at how many people are in the exact same boat.
All this said, I’m lucky: I’ve never been hospitalized, seriously ill or in any kind of true danger due to my issues. But I’ve sapped my quality of life and precious hours and days Googling things, convincing myself that I was about to die and running to the emergency room with perceived heart attacks all because of panic and anxiety.
There’s been an upside, though: I’ve finally, at almost 40, been able to take myself seriously. To do what feels good and not push myself into situations or relationships or behaviors that aren’t healthy for me just because I should be energetic and competent and happy. It’s OK to take care of yourself and your mental health; it’s not some “joke” problem that can be overcome.
Don’t fool yourself into thinking that it is; don’t admonish yourself to be stronger or more resourceful. You already are. It takes major energy and resources to keep up appearances with this stuff. People are always telling me how I appear so together, energetic and upbeat. And I am! You can be all of those things and still have earthquakes below the surface. You don’t have to be one or the other: happy and competent or upset and brooding. You can show up at work each day, be there for your kids, live your life in a way that looks completely efficient on the outside and still grapple with mental illness. It doesn’t look one way or another. Give yourself permission to break out of your mold. If you’re always the happy one in the group, give yourself permission to show someone your sadness. If you’re always the advice-giver, let your guard down and let somebody else help you. You are complex, and that’s OK. This is just one small part of you. It doesn’t define you.
Most of all, it really does get better. No matter how awful you feel at this moment, you will not always feel this way. I will almost guarantee that. I remember being 26 years old, newly married, locked in the blue-tiled bathroom of my apartment in Washington, D.C. I’d been agoraphobic for a month, stricken with panic so paralyzing that I couldn’t walk down the block. I’d taken a leave of absence from work. I couldn’t eat. I couldn’t imagine life getting any more bleak or lonely than it was right there in that tiny little room with a sunflower print from Bed Bath & Beyond and old crumpled stacks of Glamour magazine in the corner.
That was 12 years ago. Now I have two kids, I work 40-plus hours per week, and I eat a lot. I’m going to a barre class tonight. It really does get better. The bad moments really do fade. You will not always feel this way. And when you do, feel free to reach out to me.