The pandemic has brought mental health, and its severe manifestations (suicide, domestic violence) to the forefront. It’s about time, so this, is one good thing out of the otherwise doom. However, there are several points that are persistently misunderstood or remain lesser known no matter how much dialogue happens around even the relatively better understood conditions like depression and anxiety.
I have lost the closest person I have ever had and quite a few others to suicide. I have struggled with (and often struggle with) both forgiveness and anger. I have had guilt for my own thoughts (the potential ‘selfishness’ of it all especially since I have a young daughter), yet, I also want acceptance and understanding when someone chooses to end their life. I have intimate familiarity with extensive counseling and medication-based treatment plans. I have witnessed as a partner very closely, and because of my constant writing and speaking out on mental health, I have had several (mostly women but also men) share with me their struggles. I have learned from their journeys and in some cases, have had very close views of their treatment (success and challenges). I am stating these here because if needed, I am happy to share details of treatment plans and journeys to help disperse doubts, stigma, and misconceptions around this topic.
So with that, here is what I’d like to gather and summarize:
Clinical vs. Situational
This point can be stated with a single sentence, but needs to be explained for this is a key contributor to the misunderstandings around mental health. Situational conditions (say sadness or even depression, or a sudden anxious phase) caused by a life event need to be separated from clinical conditions. So when the internet advises us on controlling our minds or we look into our past and find examples of how we were able to overcome situations, we are quite possibly talking non-clinical conditions. To additionally confound this, it is not that clinical conditions can’t benefit from mind modulation. Counseling and redressal techniques – from cognitive and EMDR therapies, to well-known findings on meditation and the comparatively recent findings of neuro-plasticity – all support this. However, mental health is a spectrum. So this doesn’t imply all clinical conditions can be remedied or ‘cured’ by mind management (or, as more often put, through ‘self-belief and confidence’). Clinical conditions have a plethora of causes – from neurological to hormonal, and there are examples of situational developments triggering clinical onsets. Long story short: mental science is complex and nascent. We need to learn the facts (whether it affects us or not) especially today when we can find veritable, scientific information online before placing universal expectations of ‘think positive and push through.’ Let’s take a parallel: some patients do extremely well in cancer with a healthy lifestyle, positive thinking, and routine chemo. They have no remission. But there are patients who despite best of efforts, have their cancer metastasize. My uncle survived two years on stage four lung cancer but I don’t get surprised when I hear of my friend’s father getting detected at same stage yet passing in two months. None of these comparisons will fit apple to apple off-course, but they fit close enough to help guide our thought process towards framing mental ailments (esp. ones which can have high functioning manifestations and situational variants) as conditions, not choices.
The Unknown Middle.
There is a huge ‘unknown’ middle/overlap when it comes to mental ailments. I know of at least two individuals who had situational conditions morph into serious clinical manifestations – including psychosis – and off-course I know of numerous for whom situational conditions got better and are now more like seasonal ailments they have learned to manage. In my personal experience, I have learned and accumulated ‘tools’ over the years to be able to manage a clinical condition to the extent that it’s non-material. But it hasn’t gone away – I am not ‘cured’. It’s managed. (Note: most of these conditions – like diabetes – can be managed, not cured). Also, most mental health medications are still by trial (I have psychiatrists and several online mental health forums I can direct folks who might challenge this to). So, just because I go see a doctor and get prescribed SSRIs (Seratonin Inhibitors) for example, doesn’t mean a). the known functional dose (which for most drugs is a range) will work for me as well as it did for person X, b). will have side effects that are mirrored to someone else’s. I was, for example, put on a particular medication that I should have done well with given my history, but instead, got extremely suicidal. One important point to note here is that getting suicidal (or having suicidal thoughts) have stages/degrees of intensity. There can be long-lasting periods of such deep urge that it’s akin to compulsion. At such times, the option of ‘stopping and thinking to call a friend or helpline’ doesn’t exist. This can be neurological/hormonal/or otherwise physiologically manifested as a part of the disease or brought about by medication side effect. And again, clinical conditions most often than not will worsen with life events (situations). The phases can also worsen with progressive years or get better. Let me offer some parallels. I have been an incredibly cheerful – not a care in the world – class topper who has then, in much easier years of her life, struggled severely with a clinical condition. Meaning, the same person can be different at different times for reasons unknown. I have migraines, which I know how to manage. But ever since moving to an arid climate, I get severe sinusitis which triggers a migraine, and then, in a terrible catch 22, the migraine triggers the sinusitis back. I now don’t know how to manage my migraine anymore and have days when I can’t get up from the bed. All the medications that worked for migraine, doesn’t work anymore for the combined worsened condition.Also, I have many friends who have migraines and sinus and both. I see them faring much better, reacting much better to medications, and just, in general, being better with pain management. Meaning, the same condition, can worsen/have a different impact when compounded with new modulator, and can be different for different people.On the days I don’t have migraines, I laugh, work and party hard. Meaning, there can be better and worse days for every ailment.
I am not trying to make things too simplistic. I am trying to point out how ridiculously simplistic the most common and immediate reactions we have on mental health are: how come she/he was so much stronger in youth/when I knew them? How can they have smiling pictures out just a week back? That makes no sense, I went through worse and didn’t get depressed and so on…
- Mental health experience, and how one functions with it, varies. Just because ‘I’ am ‘strong’, doesn’t mean everyone is. I will just continue with my migraine example. Just because I know ‘Y’ can cook all day with a migraine, I don’t feel bad (or am not made to feel bad) if I can’t. Because it might be that I am indeed less tolerant to pain (which is something I doubt very few people will fault anyone else for unless the pain is a beyond any doubt band-aid boo-boo situation). But it might also be because my condition is indeed more severe, and/or my physiological reaction to it is different. Someone’s reaction to severe devastation might be much calmer than my reaction to the loss of my house. That might be because of my underlying clinical condition, a completely new condition triggered inexplicably by this loss, or because I have less mental strength/thought management power/value and support system to pull me through. This is where I feel the life coaching business need to be extra sensitive. No one is challenging that there is value there, but acknowledging medical science and being cognizant of the unknowns is a critical responsibility before promises are made on ‘manifestation out of depression’ and ‘removing anxiety through power exercises’.
- And just because I am battling, doesn’t mean ‘I’ am broken. Battling clinical conditions doesn’t make everyone non-functional or dysfunctional.They can mostly, and at most times, be high functioning. This seems to surprise us and is actually a catch 22. Because of this extrapolated assumption all of us can’t help but make on mental health, most will not be able to make their conditions public. Just like we won’t doubt if we hear an ever-smiling someone we know died of severe colon infection which they chose to fight a silent battle with instead of going public, we shouldn’t assume people owe us a real-time update on their mental health or demand constant proof to be able to believe.
Talking to someone is not easy.
1. Continuing on the above point, the reason most folks, including myself, will not be sharing our underlying condition or inner thoughts every time we smile and have a good time with you, is becauseThere’s a high chance you will not understand and not know what to do with the information. We don’t blame you for that. But we don’t want to discomfort you.
2. There’s a high chance you will not be able to get what was shared out of your mind and will talk about it behind our backs. And you will not talk about me having depression the same way you would about me having diabetes. Again, we don’t judge you for this, but this is why we will feel further inhibited in sharing our mental plight with you (call it shame if you would like to, or just discomfort – that doesn’t matter).
3. There’s a high chance that you will not get the magnitude and intensity. For example, you might understand when I am feeling sad and with best of intentions, provide some guiding thoughts; but you won’t understand why I can’t stop thinking of the ceiling fan (obsessive thinking merging onto depression) when everything in my life is well.
4. As you share this, there might be implications on my job, the opportunities I get, and even relations I can have in life. This point doesn’t require elaboration. The only way around it is by demonstrating again and again that just because there’s a mental condition, doesn’t mean there will be an extrapolation into dysfunctional.
So in sum, talking to friends or close relations won’t work because they won’t understand, will be unnecessarily worried, and would make it worse. Even with the best of intentions, most of us will fail. I have had several trained coaches give up, overwhelmed, and helpless.
Talking to a therapist or counselor is also easier said than done, and I will possibly write a follow-up piece outlining fifteen years of personal and close contact experience in multiple countries to outline why. But for now, I will just leave it by noting the key problems: finding a good fit, finding an effective fit, and finding someone who will have availability (geo-based challenges differ and include further considerations around expense, insurance, specialization, etc.). So yes, everyone going through a severe situation should reach out is a piece of advice we shell out, but we need to understand that that option doesn’t exist for most. A friend whose daughter shot herself in her head said this best: she was so surrounded, yet so alone.
Lastly, the acceptance of suicide doesn’t mean encouraging or role-modeling suicide. But acceptance needs to happen.
The most difficult point to make on suicide is the ask of acceptance in place of looking at it as a selfish and cowardly act. We have perpetuated this by making attempted suicide a criminal offense (in several nations) and by touting the idea of suicide being a sin. That all would be valid if it was a black and white matter of an individual (with responsibilities and loved ones presumably) really ‘choosing’ to take this path of ultimate abandonment. However, as we hopefully have established, the act, albeit self-initiated, is a side effect of an ailment causing the loss of life. I have been in a place where I have harbored tremendous resentment towards someone for ‘choosing’ such an act. But I am writing this piece today so that such thoughts stop one day. So that everyone who falls off the cliff, losing the battle (and trust me, they have fought tooth and nail), are understood by their loved ones. So that their end is accepted with no resentment towards them, just like we would accept the death of a loved one from a fatal accident or a terminal physical ailment.