Thursday, October 22, 2015

Denying and Accepting Mental Illness

I’m haunted by lines from psychiatrist Kay Jamison’s  Night Falls Fast: Understanding Suicide, in which she describes from personal experience how it feels to be suicidal. The prospect of suicide, she writes, was “the end of what I could bear, . . . the final outcome of a bad disease. No amount of love from or for other people—and there was a lot—could help. . . . Nothing alive and warm could make its way through my carapace. I knew my life to be a shambles, and I believed—incontestably—that my family, friends, and patients would be better off without me. There wasn’t much of me left anymore, anyway . . .” (p. 291). 

I had a friend read this passage aloud at Noah’s memorial. I seized on it, desperately, as an explanation: Noah was cut off, on another planet, literally beside himself. I made a copy for my in-laws, thinking it would help them. “It’s the chemicals in the brain,” someone told me at the memorial; “mental illness is a terrible thing.” Dazed, I figured she was right. But several months later, I was mortified that I’d been so quick to assume that Noah was mentally ill and to imply with the reading that he, too, had bipolar disorder, when the evidence was murky for anything beyond diagnoses of depression and anxiety.  

While Noah was declining before our eyes, I went in and out of thinking he was mentally ill as opposed to struggling with sensitive young adult angst and confusion. I knew he had lost a close friend to suicide, but I didn’t know that could lead to PTSD and put him at high risk for suicide. I knew his depression was getting worse and needed treatment, but I didn’t grasp that it could be a terminal illness. I didn’t know he was having anxiety attacks and that those can be scary, disabling, near-death experiences. I knew he had a psychotic episode three months before his death--I hid the car keys and pleaded with him to get help---but when his symptoms subsided, I thought it might have been triggered by stress or drugs.

I’m ashamed to say I didn’t take seriously the few hints Noah dropped about possible mental illness. “I have so many voices in my head, I don’t even know which one is mine,” he told me. I should have asked what he meant and really listened. Instead, I assured him we all have many voices in our heads and can spend years trying to find our own authentic voice. I saw what he said through the lens of “normal” experience. But Noah may have meant, literally, voices—including those telling him to kill himself.

So part of me is and has been in big denial. Jamison says acute psychological stress is one of the three causes of suicide, along with genetic predisposition and a major psychiatric illness. Is it possible to dread another anxiety attack so much that you work yourself up into worse spirals of fear? Apparently so. Is it possible to obsess and anguish so much that you literally drive yourself crazy? That’s less clear. Is it possible to contemplate suicide because you are too sensitive for this world and its pain, yet not be mentally ill? 

The reminder of mental illness as a close cousin to suicide can feel threatening, especially to families like ours that haven’t dealt with the mental health system or grappled with the label of “mentally ill” for a loved one. We knew Noah was suffering and then in crisis, but we never had to contend with self-harm, hospitals, or the police, much less the diagnosis of a chronic, severe condition and series of treatments. We never saw him as mentally ill when he was alive because he hid his anxiety attacks and suicidal feelings--but also because we were afraid and ignorant about mental illness and suicide risk and weren’t allowed to consult Noah’s doctors and therapists. Noah refused to see a professional during the last several months of his life when he was most visibly declining. It’s hard to accept the label for our child now when he’s no longer here to answer for himself or be properly diagnosed. 

We will never know for sure. Yet part of me is moving toward acceptance that Noah likely struggled with an elusive, untreated mental illness. When I feel angry now about his suicide, it’s less accusatory anger at Noah for being stubborn about treatment and letting himself deteriorate. I’m more often mad now at circumstances, at mental illness itself, at the limitations of psychiatry, and at fate for giving my child a losing number in the genetic lottery. I’m learning more about mental illness and the families that live with it and realizing that we did, too.

“His illness moved faster than his acceptance of it,” family members said at the funeral of another promising young man who took his life (Jamison, 1999, p. 67). How can I fault Noah for rejecting the bleak future of medications, doctors, and hospitals that he assumed was inevitable if he sought help? Most of Noah’s life had been about growth and accumulation—of talents, skills, friends, knowledge, experiences. Maybe he couldn’t face the prospect of life as a person with mental illness, which he assumed would be all about loss and limitations. For himself and also for those who loved him.

The more I can accept the possibility of Noah’s struggle as an illness, the more open I may be to compassion and forgiveness. That's not a reason for acceptance, of course, just a likely outcome to think about.

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