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On Mental Health in Australia

An essay written from the psych ward

Illustration by The Bender’s Art Director Grace Lehman. You can find her on Instagram @lalunagraceart or Facebook.

What makes a friend or family member especially supportive? How can we love other people more effectively? And how can we love ourselves enough to identify the people who do not?

These are the questions that have returned to me over the days and weeks of my stay as an inpatient at a psychiatric hospital, from where I currently write this essay. I’m trialing medications for Bipolar Disorder that will also be compatible with Autism Spectrum and Attention Deficit Hyperactivity Disorders. While here, I’m also doing group sessions during the day, ranging from talk therapies to arts and relaxation.

Something I noticed quickly was the pattern of guilt and alienation expressed by many of the other patients, echoing my own experiences too. That in itself is not necessarily surprising, but it’s the diversity of the people that make it an unexpected image.

There is a young, macho man who is deeply fixated on negative self-talk.

There is a grandmother who has fuelled herself only on alcohol after a harrowing career in the air force.

There is a company-owner and father-of-two who is facing his childhood traumas for the first time after suffering from a nervous breakdown.

There is a twelve-year-old who can’t let herself eat.

There is little old me.

There is no specific “type” of person. This invisibility is frightening, but it also reaffirms what we’ve been told all our lives: treat others the way you’d like to be treated, because you never know what someone else is going through.

The destigmatisation of anything is generally a slow process. Often, it cannot be fast-tracked or radical if it’s going to resonate with a wide range of people, transcending their backgrounds, educations, interests, and existing prejudices. It tends to start at the shallow end and dip its toes in cautiously.

But in the context of mental illness, I worry that the process is too slow to be of benefit to those who suffer most from the stigma, existing in a focused little bubble around a select few symptoms and contexts. The same surfaces are scratched, while other issues are inevitably neglected again. We are taught to search for perfect victims, rather than see human beings.

Anxiety-inducing advertisements about racing thoughts and sweaty palms.

Blue depression posters on the back of a toilet stall door.

A hegemonic narrative of sufferers who are somehow soft, gentle and easy to love.

But the people I meet here are definitely not fragile little lambs, nor are they walking advertisements or perfect victims. And neither am I.

Half of all Australians will experience mental illness during their lifetime. More than half of these mental illness sufferers do not access treatment. Both of these statistics are pretty disheartening, but the latter is especially grim. To me it highlights how even being in the psychiatric hospital is a privilege. This may not feel like an inherently lucky experience, but being here means I am receiving professional care, safety and support. Even if I come back again in the future, this still indicates a continued engagement with these support networks and my own mental health needs.

Of those who are admitted as inpatients, 75% report both long and short term positive outcomes from the experience. The general trajectory is improvement for those who are fortunate enough to access professional support.

Which brings me to the question of people who are economically capable (under Medicare, or otherwise) of seeking mental health treatment, but opt not to. Mental health problems are half as likely to be treated than physical ailments. Of course, there are many factors contributing to this. But given the strong theme of social withdrawal and shame amongst patients, I’ve been wondering how better interpersonal support can facilitate people’s access to professional services.

People often find comfort in a clearly-defined or aesthetically acceptable image of mental illness, but don’t necessarily develop a working knowledge around its real-life impact. I’m sure most people consider themselves good, reasonable and tolerant. But do they also make fun of the old lady on the bus who has a Teletubbies backpack full of first aid equipment, and who mutters under her breath about the thorns in her side? Maybe.

How can we identify the supportive relationships in our life? And how can we be more cognisant of our loved ones and their unique needs?

I can’t always trust myself very easily. I’m erratic, socially unintuitive and self-flagellating. And that’s not self-flagellation to admit it – those are just the facts. It’s difficult to challenge your innate dispositions and self-defeating behaviours. No matter how hard you try to go it alone, your world and the people in it need to complement those areas of improvement.

I will continue struggle around people who try to shame me into self-improvement. I will also never change if I’m surrounded by those who treat my symptoms like party tricks. I will only thrive within a social landscape that genuinely wants to see me do exactly that.

I’ve been thinking about the people in my life who exemplify this concept. What do they do differently that makes them especially supportive?

They treat our connection like an evolving relationship to be nurtured. They temper their expectations, and help me do the same. They adapt with different contexts and varying needs.

My hospital stay has given me some clarity in the distinction between helpful and unhelpful behaviours. Our connections to other people are the greatest cornerstone in our lives, and I’ve come to some conclusions about the relationships I most deeply appreciate.

Supportive People Strive to Find a Balance Between…

Intentions and Behaviour

Conveying kindness to another person is not a checklist or a competition. You don’t complete a series of quests so you can move up a level. However, you do need to be able to put your money where your mouth is. A consistent inability to follow-through may be received as though you’re treating someone like an idea rather than a person.

If a person comes to visit me every day in hospital, that behaviour certainly demonstrates a level of support. However, someone else might be more tentative about whether to visit me at all because they are aware that I become socially overwhelmed easily. This also demonstrates genuine thoughtfulness about my interests. Neither are automatically better or worse.

Textbook “good” behaviour does not infallibly portend a good character, and intention alone rarely manifests into anything greater. Supportiveness often needs to oscillate somewhere between reliable pragmatism and the consideration of individual needs. Circumstances matter.

Acceptance and Progress

A supportive person loves you as you are, but wants to help you become your best self – for your own benefit!

In the grasp of a panic attack or a particularly horrid day, I don’t need someone to tell me to pull myself together and get over it. That’s not helpful. But if I’ve been bedridden for a month with no end in sight, I do sometimes need gentle encouragement rather than further indulgence of the behavioural patterns that are making me sicker.

This is tricky territory. The best methods of encouragement vary from person to person, and often involve trial-and-error, honest communication and mistakes. A supportive person accepts your current struggles without judgment or angst, but cares enough about your aspirations to try to help you develop better habits for yourself.

Humour and Sensitivity

We need frivolity to escape the existential trap of taking life too seriously. But we also need sincerity, especially regarding our deepest areas of insecurity or fragility. Friends shouldn’t prod at your most tender wounds with a stick, but they can’t be so poker-faced that your interactions are strained and overthought.

Authenticity is important. Lightness and darkness each have their place.

Help me laugh at myself, but don’t make fun of me when I ugly-cry sometimes. The best people I know are massive goofs, but not in a derisive way that isn’t respectful of my personal challenges.

Forgiveness and Accountability

Conflict management is important in any one-to-one connection. Dealing with misunderstandings, bad days, and anguish is an aspect of mental illness. Patience is paramount, but not to excuse poor behaviour – and nor should we want others to excuse ours.

We need friends who can pull us up on our bullshit in a constructive manner, but still try to understand our challenges without spite or unfair blame. Holding grudges leads to nowhere fun, but it’s still necessary that we can identify and take ownership of our behaviour. Our social connections need to be complex and compassionate enough that we are continually learning without guilt or enablement.

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Human connection has many faces. These particular considerations reflect my own values within a supportive social connection, and would vary with personality, individual needs, and the nature of the relationship. However I feel there may be some universal takeaways here, and the element of balance and adaptation is particularly significant because it allows for empathy, error and an emphasis on contexts. Friendship isn’t a one-size-fits-all situation. Advice that is generally effective for neurotypical individuals can’t be blanket applied to everyone without a second thought.

Our interpersonal care of mental illness needs more nuance than our broader representations currently entreat. We need compassion even if we cannot always expect understanding. Ensure that you give, but identify what you receive too.

Originally published at www.thebender.com.au

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