Mental Illness
Disclaimer: This is NOT a professional, medical page. This is simply my observations based on my own personal experience.
Topics:
Why I wrote this page
Comparison of mental illness to physical illness
Muscles we're unaware of
The role of medication
The difference between mental and physical illnesses
What people can learn from this
Brief summary
Why I wrote this page
After an appointment with my psychiatrist and some things that have happened recently, I've come up with a few analogies that will maybe help people that don't have much experience with mental illnesses (or with other people that have mental illnesses) understand some of the social behaviors of people suffering from mental illnesses.
My psychiatrist always stresses to me that being bipolar is not "who I am", it's "a sickness that I have". I am separate from it. I had a hard time understanding that until Thanksgiving, when I had to go upstairs and lie down for a while - not because I was tired physically, but because I was worn out mentally.
Mental illnesses are to the mind the way physical illnesses are to the body.
For instance, if you have a cold or the flu, you rest and take medicine and give yourself time to heal. You might be able to get up and do some things, but you can't do everything you did before (especially not the things that would only make you more sick, like playing in the snow), and you often have to go and rest your body for a while. Even while you're up and around, you might feel achy and have to blow your nose a lot.
With a mental illness, it is much the same: You can be doing things that require mental and emotional effort, but your mind will get tired out and need a rest after a while. You need to do things that will help you heal (just like for the flu, it's medicine and rest - but the rest is from emotional or mental activity rather than from physical activity). You need to avoid things that make the illness worse (for a depressed person, this might include anything from watching a sad movie to hanging around with a person that tends to need a lot of emotional support). You have to realize that, even when you are "up and around", you won't be performing to the level that you performed when you were well, and normal activities will wear on your mental and emotional state.
Muscles we're unaware of.
The similarities between physical and mental illness are hard to grasp. I'm reminded of my first Tae Kwon Do class - the instructor told us that we'd wake up the next morning sore in muscles we never knew we had. The mind and emotions are like that: you aren't really aware of the "muscles" involved in keeping up most activities until one of them gets "sore". For example, a person that tends towards depression might feel good one morning, get up, get out and do fun things with people he likes to be with. After a few hours, though, even though everything is good and enjoyable, he starts just feeling down and not wanting to be there anymore. His "happy muscle" has gotten tired, and he's sinking back into the depression that is underlying it. This can work in the opposite direction with people that tend toward mania and hyperactivity - they can get things under control for a while, but their "self-control muscle" gets tired after a while, and they start splurging again.
Medicines for mental conditions are meant to help the "muscles" work properly without getting tired out.
In a depressed person, anti-depressants aren't meant to make the patient constantly happy - they're just supposed to help the person naturally exist at a higher (or "normal" for healthy people) level. Optimally, the patient should have normal, situational ups and downs; those are different from clinical or chronic depression. For a bipolar person, the goal is much the same - get the patient into a middle level that isn't always depressed or always manic, and try to keep the person there. Again, there will still be situational ups and downs, but the major swings and the excessive symptoms that come with those swings should be dramatically decreased.
The difference between physical and mental illnesses.
Most physical illnesses heal completely and are gone, while mental illnesses persist and need constant medical attention to keep them from breaking free in a person. In a way, mental illnesses are more like cancer - the main tumors can be removed, the person can be in remission, but activities like chemotherapy, medication and frequent examinations are needed to make sure the cancer stays in remission.
How is all this information helpful to family and friends of someone that has a mental illness?
First, understand that the person has an illness. The person isn't the illness - the person is being hidden behind the mask of the illness.
Second, understand that the person has to take steps to heal, such as resting, refraining from mentally and emotionally draining activities, and working to find a medicine or combination of medicines that will help the person in a more long-term fashion. The part about medicine is important, since the medicines often have to be tested and changed and adjusted many times over before the right dosage is determined, and this testing period can be very mentally and emotionally unstable and trying times for the patient. The patient will not come through this process unchanged.
Third, recognize that there are "muscles" of which you may be unaware. The most common advice I get from people who know I'm depressed is this: "Go do something you like doing, have some fun and make yourself feel better. You can just decide not to feel bad if you have enough willpower." There is nothing farther from the truth, nor is there anything more damaging to my self image and my relationship with the people that say this. Real, clinical depression is not "feeling bad". It's having mental muscles that have atrophied to the point where the patient cannot hold himself mentally at a "normal" state without getting very quickly worn out. "Pulling oneself up by one's bootstraps" is all well and good, but a truly depressed person can't hold "oneself" up for very long without collapsing and probably being the worse for it. If you haven't experienced this, you probably won't ever be able to fully understand it. But recognize that there are things people face that you aren't aware of, and that the remedies for these things are much more complex and difficult than you might think.
For a physical comparison, imagine that you're a runner. You're not necessarily a marathon runner, and you haven't necessarily won any races, but you can easily run a few miles a day. Then, imagine the person with the mental illness as someone who's either recovering from a broken leg or never done any running at all. The patient can walk all right, and maybe jog, run or sprint for a short distance, but they could never keep up with you at your regular pace. Only through time and training will they get to the point where they can run next to you. It certainly doesn't happen overnight. The patient can't simply decide that "tomorrow I'm going to run 3 miles" when he just got off his crutches yesterday. No matter how much he wants to run the 3 miles, he simply isn't going to be able to do it and will probably hurt himself if he tries to do it. For you, the running is easy and doesn't really take any effort because your muscles are conditioned to do it; you don't even feel aching muscles after the run - but the patient's muscles simply aren't able to do the things your muscles can do.
In summary.
Mental illnesses are difficult for the patient (and his family and friends) to understand and deal with. But using physical ailments and the template of physical muscles as analogies for the mental and emotional health and work of the mind may help overcome some of the fears and misunderstandings related to mental illnesses. Remember that mental illnesses are just that: illnesses. They are neither more nor less and need to be treated with the same care and patience as physical illnesses.
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