If you're reading this book, chances are that you or a loved one has been diagnosed with a mental illness. This is a scary time, filled with lots of questions, strange buzz words, and people pushing drugs at you. In the best case scenario, you need to know that you're not alone. In the worst case, you need to know that you can survive this. Here's what I, a humble devotee of mental illness, would recommend for the novice.
1. Don't panic! I know that's easier said than done. Right now you may feel as if you have absolutely no grip on reality... and that may very well be the case, if you're having a psychotic episode. The key here is to get someplace safe. Where that might be is different for most people...some people feel safe inside a crowded shopping mall, but that was the worst place for me. If all else fails, go to your local emergency room. At the very least, if you do decide to do something harmful to yourself, you're at the best place for it. Good ERs will have social workers that you can talk to. I've parked outside in the parking lot of an ER and waited for the wave of self-mutilating urges to pass.
2. You are not alone. This isn't a particularly helpful thing to know when you're in the midst of a crisis, but when you become more rational in your thinking you might be pleased to know that whatever you're going through, there are others who have gone through it, are going through it, and will go through it. That's what this book is primarily about. It's the "hey, somebody else feels the same way I do" idea. Again, not much comfort at the time of a crisis, but it helps keep you from feeling too isolated during those thoughts of, "I'm not normal."
3. Laugh. I mean, why not? If you're depressed, you'll feel like crying instead, and that's fine too. But if you can develop a particularly sinister evil maniacal laugh, it just adds to the whole persona. And really, what good is going stark raving mad, if you can't develop the maniacal laughter to go with it? Honestly, laughter does a lot for the body...it creates endorphins, it helps build muscle, it does all types of good stuff for ya. Also, laughter is really the only way to get through this. There's going to be enough crying, gnashing of teeth, swearing, etc. Develop a good hearty laugh and find things to laugh at. Even if it doesn't make sense to anybody else.
4. Keep an open mind. I know, I know, the irony is thick. You feel like your mind is slowly dissolving into little pieces, and I'm telling you to keep it open. But in order for things to help you through this phase of your life, you have to believe they will work. Some things sound pretty hokey - try 'em anyway. I once had a therapist tell me I should sing to myself. Pretty stupid I thought, and it didn't work for me. Doesn't mean it won't work for you. The therapist had a pretty good practice, and I'm sure it worked for some of his patients.
5. Find yourself a therapist and a psychiatrist. This is expensive. Hopefully you have insurance. If you don't have insurance, go to your local county or state agency and get on whatever plan they have. Some docs and therapists will work on a sliding scale - you pay what you can afford. You may, if you're spiritually inclined, find a church that has some type of family therapy program. They may be able to better direct you for your community.
a. You need a psychiatrist (a psychiatrist is an M.D. trained in brain disorders) who can prescribe and manage your medication. Despite what actors and some nutritionists say, medication is a huge help for most people. Pharmaceuticals are your friends. I wouldn't be here today to write this if it weren't for the miracle of modern drug therapy. Don't let anybody talk you out of it. If a doctor tells you to take 20mg of Prozac during the day, then by jove, take 20mg of Prozac during the day. However, and this is my caveat, if you have a doctor who is prescribing 20mg of Prozac, 20mg of Paxil, 10mg of Zoloft, and you keep complaining about being drowsy all the time, and the doctor's answer is to prescribe new or more medication, think hard about getting a second opinion. Some psychiatrists are big on overprescribing medication, not for any malicious reason other than being overzealous in keeping you safe. (If you're conked out in bed 20 hours a day, it's not likely you'll be hurting yourself or others during those 4 hours that you're awake.) Take your medication, but be sure to learn about your medication. And don't be afraid to ask your doctor questions. If he/she balks at answering, get a new doctor.
b. Some psychiatrists can be therapists. A lot of psychiatrists make lousy therapists. I'd advise you to look for an actual therapist. For most mental illnesses there's a biological component (treated with meds) and a psychological component (treated with therapy). It's been my experience that LCSWs (Licensed Clinical Social Workers) and MSWs (Masters of Social Work) are better at dialog then a psychologist (a Ph.D. in psychology). If you're the type who gets better by talking to somebody who doesn't talk back much, a clinical psychologist is for you. If you're like me and you want to interact with somebody, a LCSW or MSW seem to work better. Also, find a therapist who has only been in practice for no more than 15 years or so. The ones who have practiced longer don't seem to be up to date with new treatments, skills, or diagnoses. The newer graduates have been trained in newer techniques.
There is one inherent problem with therapy - it's an intimate relationship that takes some time to develop. If you have a fear of intimacy (and lots of us with mental illnesses do) it's a problem. It usually takes a good three or four sessions before you're comfortable discussing big problems with a therapist... but it's still three or four sessions that have to be paid for by you or by insurance. Don't instantly write off a therapist (unless they are really weird... I've had many of those) but don't spend too long trying to see if it's going to work out. (I spent 16 months with one therapist who wasn't working out, only because I didn't want to have to go through the whole screening process over again.) Always remember, the therapist works for you! He/She may have all types of rules and regulations, but the bottom line is you pay the bill, and if you're not comfortable, tell him/her upfront and they should understand.
6. Take some time off work. I admit, I was fortunate. My insurance policy at work allowed me to take 24 months off (at 66% pay) for reasons of mental disability. And my parents were able to help with bills during and after that two years. Not everybody can afford it. But I highly recommend, that if you can afford to, take sick leave, vacation, a sabbatical, whatever from work and /or school. Our jobs are the biggest stress maker. Once we eliminate that stress, we can get on with the business of getting better. Besides, I'm sure your mental illness is making you screw up at your job. If you're depressed, you can't concentrate on anything, and you're blowing the small details. You probably feel you're at risk of getting fired. Better, in my opinion, to be proactive than to have to react. If you've got some time on the books NOW is the time to take it. The World Health Organization suggests that by 2010 more time will be lost from depression and other mental illness than by the common cold or flu. Leave now, before it becomes hostile, before you need to go to the restroom and weep for half an hour at a time. If your job is making you that sick, I'd even recommend quitting and getting a different job. I don't care what you make, or how many other people depend on you . . . if you off yourself because of a menial job, nobody's better off.
7. Watch out for Stigma. In your mentally ill life, you're going to meet bozoheads who are going to say something like, "well, just snap out of it." Or "it's all in your head." Or you'll find somebody somewhere stereotyping mentally ill people as being lazy or deadbeat, or a danger. Ya know, you don't need that crap. That's where groups like the National Alliance for the Mentally Ill come in handy. Their Stigmabusters alert warns you of up coming media events (TV and movies and the like) that portray mentally ill in one of the stereotypical ways. Support groups are also good resources to reach out to, when you feel the man is stepping on you. There's nothing worse than being depressed and then watching a depressed person being portrayed as lazy . . . it makes you, well, even more depressed. Again, being proactive about things helps. Writing letters to TV producers, movie companies, and legislatures helps channel your individual frustration, and lets other people know that, "hey, we might have some problems, but we're still human beings."
8. Learn. The web is a great resource. Learn what you can about your particular diagnosis. Hopefully your psychiatrist and therapist are up on the latest, but they may not be. New therapies and medications are being produced every year. Maybe the Geodon isn't working for you, but maybe Abilify will. Abilify is pretty new, not all docs know about it yet. Never hurts to vet it out with the doc. A lot of the information in this book is stuff that I learned just by reading various books, magazines, news articles and web sites. Knowledge is power.
9. Teach. Your experiences are different and unique. Even though what you may be going through is similar to several thousand people out there, what you're doing and how you're doing it, is different. Maybe there's a way to showcase that. Maybe you can help newbies going through this at a support group, or volunteer at your local NAMI chapter. You'll learn more about yourself and what you can and cannot do, by helping others go through it.
10. Don't give up. If I had a nickel for every time I wanted to off myself, I'd be dead, but rich. Don't give the devil the satisfaction. It's a (and I hate using clichés) a permanent solution to a temporary problem. Some days are going to be better than others . . . some days are going to be down right shitty. It's even possible that tomorrow may be worse than what you're feeling now. But some day, somewhere, things will get better. It takes work. Going through a mental illness is one of the tougher things I've ever done. Most mornings, I don't want to get up. Some days I don't. But I've never stopped trying. I may have taken extended periods of time off, and that's okay for you too . . . but don't give up. Keep the hope of something better alive. That's what it takes to get better - hope.
Stewart Young continues to learn about his illness while overcoming the many obstacles placed in his path by his illness and by society. Borderland: A Life on the Edge, is co-written with his ex-wife and former caretaker, Monique Young. The authors can be reached at monique@moniquewrites.com.
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