What Does Mental Illness Look Like?

Mental illness, like Sybil, has many faces. It can be everything from the bag lady muttering gibberish while pushing a grocery cart to the Fortune 500 mogul who is perpetually exhausted because he feels compelled to check and recheck documents that have already been approved until the wee hours of the morning, adversely affecting his performance, but he cannot stop. It can be anxiety on steroids; it can be profound and disabling depression; it can be a false high with lots of serious, negative consequences.

Obviously, there are forms of mental illness that aren’t so disastrous, but in my blogs, I am most often referring to individuals with SPMI (Severe and Persistent Mental illness) – these are my people. People with profound mental disorders are especially at risk for doing a tango with the Beast that is suicidality.

True confession: I’m currently en route to Houston to meet with my doctor and the rest of my team. I trust them with my life – literally – and I desperately need their help. The past two weeks have been straight-up hellish. I’m cranky and irritated to the nth degree that I am slipping, especially after fighting so hard to keep things together. But, alas, here I am, just hoping they can put Humpty Dumpty back together again.

The first thing my doctor needs to address is that I am just about not sleeping. I am clocking between two and three hours of sleep per night. Unfortunately, I know myself well enough to need 9 hours of sleep to be at my best. (There’s the belief that we need the standard eight hours of sleep to function at our best, but there are those who thrive on less than that, and there are those of us who need a few more hours to feel refreshed and ready to tackle the day.)

I am a chronic insomniac. I have all three major forms of sleep disorders: initial (I can’t fall asleep), middle (I can’t stay asleep), and terminal (I wake up too early). My true nemesis is falling to sleep, but the other two forms of insomnia often nip at my heels. When I become manic, I don’t need sleep – I exist on fumes and the world is my oyster. (Thank God mania doesn’t visit me often; when it has, it has been a shit show of epic proportions.)  When I am depressed, I ruminate and have racing thoughts and monkey mind when I try to sleep – it’s like trying to sleep with sirens going off in every direction. My brain is on fire.

This current depressive episode is robbing me of much-needed sleep. One of the reasons this episode is going to be treated while I am an inpatient at the hospital is because of my brain, which I can best describe as volatile. When I am this sick, all bets are off, and suicidal ideation becomes a constant companion.

I use a scale to describe where I am on a continuum of suicidality. While not being suicidal would be absolutely awesome, I realize that ship has sailed. I became chronically suicidal in the sixth grade. And I’m 54 now. Do the math: instead of trying to eradicate my suicidality, I manage it. I’m not saying that’s what you should do – it’s just what works best for me.

Back to the continuum: at its best, I describe myself as being the status quo. This means that, yes, I am suicidal, but the actual risk of my becoming actively suicidal and possibly acting upon my urges is extremely low. When the Beast starts to exert its authority, there is an uptick in my suicidal thoughts: I refer to this as the Beast shouting. It’s imperative for me to communicate and work through the urges with my treatment team, or I risk the Beast ratcheting it up to shrieking.

When the Beast is shrieking, I am losing the battle. Suicidality reigns supreme, and I feel like I am in a black hole with nothing to grab onto to pull myself back into the land of the living. So, you ask, where am I currently on that continuum? Sadly, I have gotten to the point where I don’t feel like fighting the “good” fight. If I could just curl up and die, I would. So, what’s stopping me?

Well, there is something called a contract for safety. It is a therapeutic tool for keeping oneself safe that many say is ineffective. Given that, it may seem odd that it has probably been the most successful tool I have to fight the Beast. Why? I think I’m oddly lucky: I truly believe in keeping my word. If I contract with my therapist or doctor that I will not harm myself, and if I then find myself at a crossroads, I will seek help.

Also, my doctor has told me that if I suicided, he would be angry at me. It may seem silly – after all, if I’m dead, his being angry is sort of a moot point. But as in contacting for safety, there is a very strong pull not to make him angry. What it boils down to is finding what works for you – what will keep you afloat and the Beast at bay. For me, it means going into the hospital where I literally hand the reins over to people whose very job it is to keep me safe, and I can work on shoring up my immunity to the Beast. If you are struggling, find the things that keep you grounded, safe, and alive.