Two years ago, almost to the day, I hit – careened into, really – what I retroactively know was my ‘rock bottom’. I was walking down Adelaide Rd at 10.30 in the evening and I’d only just got out of bed, because I knew I had to. It was raining and I was crying. I’d just been diagnosed with a mental illness and was on my way to pick up my first packet of medication from the all-night pharmacy, and I couldn’t stop myself from thinking: “How has it come to this?” Or, to invoke renowned sad-fuck Leonard Cohen, “where are you now, golden boy / where is your golden touch?”
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New Zealand has a ‘high’ prevalence of mental-health disorders. The most common is ‘anxiety disorders’, which usually manifest themselves as either generalised anxiety disorder, obsessive–compulsive disorder or panic disorder, all of which are pretty nasty. That is closely followed by depression, dependency problems and bipolar disorder. Schizophrenia, psychosis and eating disorders are less common, and occur at a rate consistent with worldwide levels. It’s anxiety and depressive disorders that we supposedly excel at, with the second-highest rate of incidence in both conditions in the First World. Māori and Pasifika people and men in the 16–24 age bracket are at especially high risk. We really put the OCD in OECD.
These findings, however, should probably be measured with a hefty side of salt. The problem with gauging mental illness accurately is the many misconceptions and taboos surrounding it. Mental illness is chronically under-represented. It might just be that NZ has a more representative way of compiling the data than other countries. Though not scientifically verified (yet), I’ve thought for a while that everyone goes through mental duress at some stage of their lives. We expect our bodies to get fluey every now and then, and our sinuses clogged. Why not extend the same fallibility to our brain chemistry as well?
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The first couple of weeks post-diagnosis were beyond rough, as the diary I decided to keep at the time can attest. Here, have an unsolicited excerpt, I insist: “For me, [my mental illness] is seeing photos of you before IT happened and mentally captioning them: ‘Philip McSweeney, pictured here in happier times’. The happier times, you assume, are irrecoverable and committed only to the past. [My mental illness] is the horrific moment when you show someone a video you think is funny and they don’t laugh, not even a titter, but it’s spread out perpetually and permeates your every waking moment”. I read it now and think “Oh my god, 14-year-old poetry corner much”, but I was aware of how melodramatic it was at the time too and that just makes it worse, in many ways, knowing how stupid and pathetic you’re being but not being able to divert your piece-of-shit brain away from anything else except ‘the terror’, and honestly, the saccharine is so, so much better than the alternative.
Two years on, and I bracket my life into periods pre- and post-diagnosis. I still unconsciously position myself closest to a door in a room, and make mental notes of exit routes so that if I need to, I can escape. It hasn’t gone away. It waxes and wanes. Some days are fine. Some are great. Some are dreadful. This is normal. This is fine.
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New Zealand also has a problem with sufferers with ‘unmet needs’, or people who do not – or cannot – access the treatment they require. This predictably affects the poor, those with ‘lower educational attainment’, Māori, Pasifika and Asian minorities at greater levels, but it occurs at all strata of society. According to one estimate, only 39 per cent of people with a mental disorder consult medical services. The Mental Health Foundation ascribes this to the patients themselves and the continued stigma surrounding mental health: “the most common reason for delaying seeking help, stopping treatment or not seeking health were attitudinal”. The fault is imputed onto sufferers rather than the people in a position to help. But is this an adequate reason, or just equivocation? Few ever discuss health professionals themselves in the context of unmet mental needs; are they free from culpability? It’s convenient for them to blame stigma, but if this doesn’t address the deficiencies on their part, it’s a cop-out.
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I wouldn’t be so callous or hubristic as to say that the health system failed me, but I don’t think it did right by me either. The first time I went to a GP, I was allotted with something much less serious than what I suffered from. The second time, it was something much more. The third was not quite ‘just right’, as I’ve discovered one-and-a-bit years later, but was at least vaguely close. Here’s where the structural problems come in: after requesting my medical record, I discovered that the first doctor that I saw had actually written that, in his professional opinion, I had a mental illness, but for reasons I don’t know, he decided not to broach it with me. It was sheer bloody-minded obstinance that got me the treatment I needed at the time: three doctor’s appointments later and I had a prescription for some pills, but no strategy.
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Positioning the issue of people not reaching out to mental health as a patient issue is internecine. It attributes responsibility to a vulnerable populace, but it also doesn’t challenge the current effectiveness of our health services. Without this critique, mental-health services are doomed to the status quo, and the status quo is clearly failing. A recent study of mental health in New Zealand claims that the best way of treating mental-health issues is, quite simply, “quality and quantity of treatment uniquely relevant to the individual’s disorder”. An average appointment with a GP costs around $80, unless you can afford insurance or jump through the energy- and time-draining hoops that might afford you government subsidisation. Meetings with specialists are even more expenny. The Wellington anxiety clinic charges about $180 per meeting, and applying for government funding is no walk in the park – especially with cutbacks to WINZ services being rolled out under National’s auspices. This is all assuming you get a referral from your GP in the first place, of course. Some may diagnose you incorrectly; some may give you pills to patch, but not address, the issue. And it’s all very well to say the New Zealand health sector is overburdened, but these structural failings are occurring at the expense of people’s mental health and livelihoods – according to one study, three per cent of the population per year are so debilitated by their mental health that they cannot work or function.
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When people ask me what having my mental disorder is like, the first word that comes to mind isn’t ‘sadness’ or ‘despondency’ but ‘terror’. Actually, this is a fitting point at which to segue. What people don’t get about mental illness, I think, is that when you’re suffering, your measure of time becomes shot to shit. You start living in hour-long, minute-long, second-long increments, hoping that you don’t dwell on IT too much or that you don’t have an ~episode~ or whatever. The largest unit of time you’re capable of processing is a week, maybe a month at a stretch. Another thing: when people with mental illness say they can’t get out of the bed, can’t get out of the house, it’s not that they really really don’t want to or that they can’t be bothered or whatever. They Actually Cannot Leave The House. Last quick observation: when you’re mentally unwell, you learn the value of escapism viscerally. An episode of Futurama, a leisurely incognito porn sesh / cheeky mastie, a favourite book, a Spotify playlist called ‘depressing songs’ to commiserate with and Dr Feelgood to try to snap you out of it – in vain but for moments, maybe, but those moments fucking count.
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Identifying exactly where mental-health services are going wrong is difficult because the whole concept of ‘treating’ mental illness is fraught. Most of the articles surrounding pills like Prozac, Zoloft, fluoxetine et al position themselves as polemics, jeremiads, or sermons bemoaning ‘over-diagnosis’ or ‘pill-popping teenagers’ without attempting to integrate much nuance (here’s looking at you, New Zealand Listener. Honey, you are no New Yorker.) It’s incontrovertible that antidepressants, and especially those of the SSRI variety, have risen to levels of ubiquity. You are almost guaranteed to know someone on them: at one gathering of old friends, we were all shocked to discover that we were all on the same prescription. In a way, our society has embraced better living through chemistry. The genuine worry is that it reaches an extent where regular-ol’ sadness or life-pain is pathologised and pills are prescribed superfluously. In the words of researcher Katherine Sharpe, “to live in America today is to be invited, again and again, to ask ourselves whether our problems are symptoms”. In the face of corporate, medical conglomerate interests, over-prescribing could be a genuine problem.
But does this really matter? At its simplest level: if taking a pill helps ameliorate symptoms, who has the right to give a fuck? Regardless of whether or not you need the medication or just get a boost from it (a pretty thin line to draw, in truth), if it helps it helps. Being depressed, anxious, mood-swingy is miserable. There’s a pill for it. There’s a weird societal perception, maybe a vestigial organ from times of Judeo-Christian directives, that there is nobility in suffering; or that to achieve and accomplish, first you must suffer, masochistically take the faecal matter life heaps upon you, and retain a stiff upper lip throughout. This is bullshit. Yes, diagnoses of mental illness keep rising; if it’s helping people in need, who cares a fig?
Medical practitioners occupy a weird space when it comes to stuff like this. Many are wary of prescribing pills based on the lambasting they get when they do, or take conservative mindsets with them into their practice, allocating antidepressants only for ‘severe cases’. On the other hand, some GPs will hand them out like piquant-tasting candy without recommending other courses of action that need to be taken concurrently with medication. Antidepressants are shown to be exponentially more effective when used in conjunction with CBT (hey, that’s a column in our magazine!), therapy, counselling, or other one-on-one and group sessions. Pills can abate symptoms, but do not tackle underlying frameworks or issues at play.
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Unfortunately, as I mentioned earlier, this period of healing takes time: the stats say at least 12 weeks. Time for a mentally unwell person, as I mentioned earlier, is perceived in a vastly different way, making the remission period a veritable lifetime. There are responsibilities in everyday life that cannot be put off either, like work, chores, bill payments, schooling, socialising. Processing these and trying to get well is a nigh-on insurmountable task. Perhaps what we need is a more compassionate framework when it comes to mental-illness sufferers encoded into law and societal norms.
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When antidepressants work, the most common response – according to doctors and health companies – is “Thank God, I finally feel like myself again”. I don’t want to diminish the experiences of those who do feel like that, but it does beg the question: what exactly is ‘myself’? We represent periods of mental illness as blips on the radar of life, weird anomalies that are at odds with your well and happy self. What, then, of people who have been on antidepressants for the majority of their lives – what selfhood are they allowed? In the process of preventing my illness from defining me, am I supposed to excise its importance in my life entirely? I think often about how my mental illness has developed me as a person. Some will be the source of endless, unverifiable conjecture: is the reason I’m attracted to strange, melodyless music because I find comfort in having my brain chemistry communicated in the abstract? Others are less opaque. When I’m well, I feel brave and proud and warm and loved. When I’m not, I have ways of coping. I feel emotionally equipped to deal with others. I have more of an insight into compassion, having seen it in its purest form extended towards me countless times. We need to restructure the way we approach mental illness if we are going to get any closer to treating it effectively.
And if your mental illness doesn’t improve? There is nothing wrong with that. Do not feel as though you’ve failed anyone, least of all yourself. You do you and fuck the rest. Platitudes about it ‘getting better’ are not misplaced. Do whatever you need.
Finally: if you don’t have a mental illness, what should you do? If they need space to be alone, for the love of all holy deities let them have it. If they need you, listen to them and commiserate. Don’t use words like ‘depression’, ‘schizo’, ‘bipolar’ and ‘OCD’ flippantly, as it minimises the struggle of the sufferers (and why would you say ‘OCD’ when the word ‘persnickety’ exists, honestly, ya jabroni). And consider it a learning experience. The value of seeing the way that others struggle with pretty horrific feelings (whether they’re medicatin’ or not) is tremendous. And if you do have an illness: accept that other people have their own shit, and if people do want to break off relationships and friendships, that’s tough, but 100 per cent their prerogative. Remember, though, that support is always there somewhere. Find media that makes you feel comfortable – my go-tos are Cannery Row, Bitch Ass Darius’ ‘Follow the Sound’, and Gilmore Girls (newly streaming on Netflix ayyy) – pick your own. Most importantly, love and appreciate yourself as you are, you majestic thing, because you are worthy and wonderful and special. It’s hard. It’s kinda nice. It’s vital. Best of luck out there. Keep it tight.