Mental illness is a demon that exists only in the mind. The intricacies of this internal struggle can only be intimately known by the person experiencing it. To add to the difficulty of articulating one’s thoughts and feelings, the social stigma associated with it only exacerbates the situation, leaving many feeling isolated, silenced and trapped in their own heads. Mental illness is real, a living reality that many have to struggle with and accept. In Australia, just slightly less than half of us will experience a mental health condition over our lifetimes.
My experience with depression is as a bystander; it tormented someone dear to me. For confidentiality sake, I shall simply refer to him as Jake. I watched how Jake changed–it was subtle at first, days of low mood and a general lack of interest. But what’s different about depression is that it does not just pass. It just hung around, like a persistent black cloud of doom following Jake around. He became more paranoid, suspicious that others were going to harm him. His fingers trembled as he flipped the papers, glancing through the headlines unseeingly, and he was hardly the type to be timid. At the height of his depressive episodes, he stopped reading the papers altogether–a pastime he dearly cherishes and religiously sticks to every day. It was such a helpless situation, trying to cheer up and interest a person with no intrinsic motivation for life. Every little thing I suggested–going to the movies, a walk in the park–he would turn down, without giving any reason. He spent his days just lying in bed, staring blankly at the ceiling.
I began to resent his behaviour. It is unimaginably difficult to disassociate a person from his actions, and from the outside looking in, I felt that he was to blame. Why did he have to make everyone around him so miserable? Can he not see how much effort we put into trying to engage him, to make conversation? Why won’t he talk to us about what he was facing? It was more than just pride, it was part of the depression. He felt burdensome, and hopeless about the future. Who wants to talk about that? And even if he were willing to, who would be strong enough to sit through the darkness with him unflinchingly, to be that pillar of strength?
Jake left ominous hints, mentioning how it would be nice to “just sleep forever”, and “down sleeping pills”. I chose not to take it to heart–there was little I could do, no instruction manual or concrete action to solve his problems. After actually having to physically intervene to stop him overdosing, we brought him to the Emergency Department of a nearby hospital. (It was not the first time, and it was not going to be the last.)
“I just want to end my life.” He told the triage nurse. Hearing those words, I felt as though an ice-cold hand was squeezing my heart. Jake had never openly admitted that in front of me before, despite my best attempts to communicate.
Jake was hospitalised (and discharged, and readmitted, several times)–when he was in the ward, it afforded all of us some peace of mind. Constant worrying and monitoring, especially of the medication regime, exacted a high toll. It took time, patience, and several rounds of electroconvulsive therapy before Jake became once again, the person I once knew.
I still find it difficult today to speak of this. During that hellish period, I confided in no one, save one friend. Jake himself does not remember much of the time, or perhaps it is too painful to speak of it. The invisible nature of psychiatric illness, coupled with the undeserved stigma and shame surrounding it, contributes to this oppressive shroud of silence around the topics of depression and suicide.
As that experience with depression recedes into history with every passing day, the emotional trauma becomes easier to handle, and forget. But I also know that depression is recurrent–with a past medical history of mental illness, one is far more likely to slip into another depressive episode, particularly if subjected to environmental stressors–retrenchment, death of a loved one, amongst others. Jake’s mental health cannot be taken for granted.
The same goes for us as medical students. The culture in medicine is that of fierce, ceaseless competition, within ourselves and between our peers. There are high expectations placed on our shoulders, by well-meaning family, friends, and the general public–to know the answers to endless questions, to be skilful in performing complex procedures and examinations, and to be compassionate, caring and sympathetic. Not all of us can deal with all this circulating cortisol and caffeine–most of us just get by however we can–but some suffer more than others. Just within the first half of 2017, already three young doctors in New South Wales have taken their own lives.
Perhaps this is why we all should be kinder than necessary, for we cannot discern a person’s mental turmoil from appearance. If you know of anyone who might need help, or if you need help yourself, please do ask, even if it means you have to fight your gut instinct to bottle it up. Please. Far from being a burden, it is an honour to be entrusted with a friend’s problems. There are hotlines to call as well, with three notable ones below. Just in case.
Headspace (for youth): 1800 650 890
Mensline: 1300 78 99 78
Lifeline: 13 11 14
Feature image by Masahiro Hayata at Flickr.