Adapting or coping

I often read blogs or writing by other people with mental illness – I find them interesting and inspiring, and often curious. After all, we all live within the confines of our own experience, however much we think we ride above it. Even as we start to understand, it often changes. Perhaps we get a little better at seeing – there are those moments when something suddenly falls into place – but often we just get more used to ourselves and our ways of managing life. After a while, we no longer know what they are.

Whatever people say, there is still huge pressure to be OK – to show that having a severe mental illness is compatible with success in career, love and life (possibly in that order). If, as seemed likely, my career had floundered in the early days of illness, I would not have been seen as any sort of role model for ill doctors. I am not going to be black and white, and say things would have been terrible. Who knows, they might even have been better, in some ways. Less stressful, less pressure, possibly the time and space to start writing at an earlier age. I will never deny the financial benefits of a successful career as a doctor, but it can come at a considerable price. Most of my friends aren’t doctors, and they seem to get along OK. But, what I am really trying to ask is why we praise people who have succeeded, perhaps against the odds? Should we not instead ask what this has cost them, and why it would be good for others?

As always, I am immediately pulled back towards the happy medium – I can’t stop saying how glad I am that things worked out for me, which is probably concerning, and even annoying. But doing this is over-normalising the situation faced by people who have mental illness – some may want, and be able, to do this, but others may not. Some people don’t get better, and those around them need to adapt, so that they can help and support them to cope. Differences should be accepted, not brushed under the carpet. It is also possible that some people have an episode of illness, then never become ill again. They will understand what it is like to be mentally ill, but not the ongoing grind and turmoil of ‘subclinical’ (whatever that means) symptoms and fear of relapse. Perhaps more importantly, they may not be expected to continue to take psychiatric medication with all its side effects.

I hope this isn’t sounding bitter, as that’s not the intent, but my feelings around my own illness have been a little bitter of late, and I expect that’s trickling in. I have short periods when I’m very unwell, long periods when I’m quite well, and probably medium periods when things aren’t quite right. It’s impossible to explain, and I’m very bad at trying. I was relieved when I discovered some time ago that many people with bipolar disorder have comorbid anxiety, because this has always been a problem for me, one which waxes and wanes a little as my mood does, but perhaps less obviously. So I may feel possessed by anxiety, but my mood isn’t too bad, so everything is all right, only it isn’t. Anxiety can also be a trigger for relapse, something of which I am uncomfortably aware.

Like everyone else, I’m affected by the bigger and smaller and more personal aspects of the outside world – none of us is a biological island. I can usually hide anxiety fairly well, and I suppose that’s part of the problem. At home, my partner and I have developed adaptations over the years, which manage my anxiety, and I’m not sure if they are helpful or not – they may be more about avoidance. But we live a reasonable life, and have friends and family, so something’s working. When more anxious, however, I often catastrophise about how I would manage without him, though, which is less helpful, and hard to talk about.

At work, I am less sure how to adapt and cope. I have had many meetings with different managers, saying they will support me and make whatever adaptations are required, but they don’t know what to do, and I don’t know what to ask them to do. So I just carry on working and wondering why it’s all so hard. I am very lucky, in that I work part-time, but then so do many doctors now. This isn’t particularly about my illness, more the stage in my career. I am even more lucky that I don’t do on-call, but neither do any of my colleagues in my specialty.

Perhaps it all comes back to the great unspoken – literally. It has occurred to me that my writing over the past few years may have been a not very subtle attempt to do just that. But it’s much easier to tell the narrative of patient to successful doctor than one of ongoing struggle. I think the latter might be more honest, though, and a better one to tell people, who may otherwise feel tricked by the rags to riches story that never really happens.

My last manager got me a phone in my office (my mobile doesn’t work there). This was positive, mainly because, like many others, I experience significant phone anxiety, and prefer to be on my own to make calls. But, of course, I couldn’t tell him that was why, which might have been useful, and would perhaps have opened some form of conversation. Instead, I manage my life by obstinacy and mild avoidance. I would like to talk to someone about these difficulties, but I worry even more about the look of horror on their face as they search for the nearest exit. But how can you make adaptations for someone, when you don’t even know why you’re doing it?