Mental illness is very personal, and also very immediate. When it happens to you, it is all that there is, surrounding you, bending your thinking, affecting what you say to others. But those people that are listening to you are not always in the same place as you, even those who have experienced similar illnesses and difficulties, and this can be a problem.
I always think that mental illness makes me very selfish. I want people to see what is wrong, I want them to help me, and to understand what I am going through. This is not necessarily unreasonable, but it might be very difficult for them. My partner probably tries to ignore the early signs, largely because he hopes they will go away, which sometimes happens, and I can see his point. But then I jump to immediate conclusions – he thinks there’s nothing wrong with me, no-one thinks there’s anything wrong with me, I am a fraud. He can’t win, really. And normally he provides me with the most validation of anyone, saying that I do have an illness, and that he has no doubt of this. He has told me that I get so depressed I can hardly speak, and that, less often, my thoughts seem to move so fast that, guess what, I can hardly speak.
But the times in-between worry me more – when I’m not quite well, but not so bad that I’m obviously ill. I may then be acting slightly out of character, one way or the other. I do usually have some idea that things aren’t quite right, but, but you can’t just opt out of life because of that, and it can all get a bit unclear. When I am very depressed, I essentially move out of life until I am considerably better. But when I am a bit depressed, a bit high, a bit irritable, I think that the ideas and feelings that I have are all reasonable and founded in fact. But what is fact? Is fact the euthymic me, the depressed me, or the irritable or elevated me? At any one time, whichever one dominates seems like the true me, and what I see then is the true world.
The problem with this is that later you look back at it and think – what was I thinking? Some of these may be minor issues that affect no-one else, like listening repetitively to a particular song or piece of music and believing that it is divine. Some may be of more concern, and probably include interactions with others. I suspect that sometimes I am very irritating – I am confident that my partner finds me irritating, and also that my psychiatrist finds me irritating, but at least they have a context in which to place this. I like to think that they know that being irritating is not the real me, or at least not the only me that is available.
It can be equally difficult with friends or patients, who also have fluctuating illnesses. I have often been asked if being a patient myself makes me a better psychiatrist, and I don’t, but I think it has helped me to understand the changing nature of presentation. Just because someone presents as depressed and angry, even self-harming, does not mean that this is what that person is. With time, treatment and patience things will change, and it is so important not to make snap decisions about illness or personality. I know there may be times when illness is very obvious (for example acute psychosis), but this is not always the case. People may say things at times of illness that they would never say when well, and they may be mortified if others see those comments born of illness as their true opinions.
It does leave you in a horrible situation, however, not being able to trust yourself. I am lucky that I have mostly very understanding people around me, but it can’t be easy for them when I say – again – that I’m not actually ill, that this time I really mean it. What should they do? After all, I have capacity, and the right to my own views and opinions, and it’s just a bit unfortunate that they are subject to what is rather obvious fluctuation. I suppose in some ways I’d quite like to say to all who know me – this is what might happen, be aware. But it’s frankly too embarrassing, for either side. Fortunately my managers at work are aware of the situation, largely because I’m afraid I’ll resign when depressed, and have attempted it previously. I did resign from a couple of bits of my job in my most recent severe episode – I still don’t know whether that was a good thing or not. However I remain afraid that I might make decisions when even mildly unwell that could have far-reaching consequences, and it’s very difficult to know how to manage this.
If I have one piece of advice, for me or for others, it would be to look out for irritability. In my view this is a key symptom or sign of many forms of mental illness, both in the early and the later stages. It can be misinterpreted as simply being annoying or bad tempered, but it’s very easy to say stupid or even nasty things, that seem entirely reasonable, as a result of your inflaming mind. I know, I’ve done it. I also try now, not particularly successfully, to keep away from social media, and probably other electronic forms of communication. No-one can, or indeed should, force anyone to do this, but I think, for me, at least reducing it at such times is a good plan.
It is important to emphasise that saying the wrong thing in these circumstances is not the same as questioning, denying or confronting when this is required, as it often is. I am only saying that mental illness can mess with your views, and leave you feeling you have said things that you don’t actually believe.
I hope I haven’t said the wrong thing.