I have talked about several memoirs of mental illness that I’ve found to be absorbing and brave. I just in fact read two by Marya Hornbacher, in reverse order of when they were written: “Madness” about her struggles with severe bipolar disorder and alcoholism, and “Wasted”, her first book about her serious long bouts of “bulimarexia” before she found out about the bipolar illness.
Anyway, I think one of the most challenging topics around mental illness, (besides acceptance that you “have” the diagnosis, which in itself is big and can take many years of illness for someone to finally accept it as a biological illness that needs to be treated with medication), is the day in day out living with your mental illness.
Many People are remarkably resilient and can return to their everyday lives quickly after a bout with psychosis, or an episode if some sort or relapse.
However the constant battle to stay stable and healthy, to keep up all the self-care required to keep illness at bay, that requires a dedication and perseverance of a rare sort. As these memoirs show, it isn’t enough to just be taking your medications as prescribed, although that is a big step forward, but usually, there needs to be some sort of consistent therapy and/or peer support group or group therapy. Along with that, people taking meds need to be aware of mixing them with alcohol and other substances. Part of regular self care involves regular exercise of some kind, engaging in soothing and relaxing activities, and eating healthily. Soothing self talk is key, especially for people hearing mean voices and those who have a running judgmental commentary going on in their brains. Many mindfulness meditation techniques are very useful.
For some, even after severe psychosis and several hospitalizations, life returns to “normal” and taking ones meds becomes like brushing your teeth. These people tend to take good care of themselves and push the mental illness to the side as they go about their day.
For others, it is quite the opposite. For example, for many people with eating disorders “under control”, there is a daily battle with the mind obsessing about body and/or food intake, and it can be frustrating to have mastery over the self destructive behaviors but not over the “sick” thoughts. For these people each day is a battle with their demons.
The same is true for many with bipolar disorder and schizoaffective disorder. Taking morning meds begins the day with the reminder “you have to watch yourself. Be vigilant. This could happen again…”
For these people just having or struggling daily with a mental illness can be exhausting. Self care plans can seem daunting and overwhelming. There is a certain kind of “burn out”, for lack of a better word, that occurs. This person is doing everything s/He is supposed to do. But, “I’m sick of dealing with this. I want it to go away. It’s too painful to try to be stable…” These kinds of thoughts can lead to suicidal ideation. In this case the fantasy of suicide is not directed outwards at wanting to hurt someone else by means of the ultimate form of self destruction, but is really a response to ones situation and being too drained and exhausted by the constant battle of ones own mind. For these people , every day starts with the profound ultimate choice:”Do I still want to live or am I ready to die and thus admit defeat over my illness.” S/hemust recommit to life every morning and choose the hard road of continued extra work, pain and exhaustion. Unfortunayely, once in a while the answer is clearly “no”, and then a well thought out suicide is planned. This is usually not the type of suicide “attempt” cry for help. In this case the person has already shouted and received help and support, but the illness wins over as it is simply too much to bear.