(Confronting content ahead)
One evening about eight years ago:
I pretend to share dinner with my husband on our deck. The air between us is loaded with the conversation we are about to have. I drag my eyes from my untouched food up in his direction and ask:
‘Why can’t you just let me go? Haven’t I suffered enough?’
‘How can you be so selfish? I’d be explaining to our children why you left us for the rest of my life.’
The tiny bit of energy I have left coalesces into a red-hot ball of anger
‘Don’t you dare call me selfish after everything I have been through. Ever! I wouldn’t be leaving you. I’d be doing you all a favour.’
The tension disintegrates. He comes to my side and pulls me up and into his arms. We are both crying.
And the next day I do what I must, even though I am beyond tired of fighting, even though the very nature of my symptoms prevent me from fighting, I go back into hospital.
And he does what he must, even though he is beyond tired of carrying our lives, his job, our children, all with no end in sight, and he makes the childcare arrangements, adjusts his work hours, calls in the help he needs.
Supporting someone through mental illness is challenging at best, horrendous at worst. It’s hard to feel sympathy for the symptoms it presents. Most of us can empathise with someone who has a nasty cough or is in a wheel chair. But unless we stop to think about it, it is much harder to empathise with someone who (amongst other things) might be unmotivated, irritable, pessimistic, irrational, aggressive, or maniacally talking over the top of us.
In an ideal world the person with the mental illness has insight, good medical care, and no stigma hindering access to that care. If all these things are in place, they should be able to take responsibility for their illness and managing its symptoms.
We don’t live in an ideal world though. Until stigma is eliminated, access to good quality mental health care is no longer means dependent, and everyone has a better understanding of what it takes to live with a mental illness, we need to give those suffering the illness a little flexibility.
This doesn’t mean a free pass. It means pausing before condemning. Stopping for long enough to consider what it might be like to not have control over your feelings or behaviour. It means imagining being covered in mosquito bites with your hands tied up, and then someone runs a feather over the bites and you are not allowed to react. The pathological irritability and noise sensitivity I experience during mania – feels a bit like that.
Because mental illness often affects the sufferer’s behaviour negatively, the challenge can be differentiating symptoms of illness from just bad behaviour. True bad behaviour doesn’t resolve with the episode of illness.
There’s a specific type of disconnect that can spring up between the mentally ill person and their support people, as evidenced by that conversation I had with my husband.
On the evening I described, I had been in and out of hospital for over a year. I believed I would never be well and that my family would be better off without me, not because I was selfish, but because those are symptoms of severe depression. I have never considered suicide when I’ve been well.
My husband’s reaction was filtered through his exhaustion and worry. He cares more and understands better than most, and yet lost track of the fact that being angry at me for being suicidal was as helpful as being angry at someone who was gasping for breath because they are gasping for breath.
But there is a way through that disconnect. You each do what you need to look after yourselves. Because unless you look after yourself first, you can’t look after each other. The person with the mental illness needs good professional mental health care. The support person can not take the place of that. Perhaps the most important role of the support person is not to fix or manage the illness. It’s to look after themselves well enough so that they can be there for the patient, not just through the episode of sickness, but at the other end of it.
I’ve had people say to me:
‘Gee, you’re lucky your husband stayed with you through all that.’
But it isn’t luck. It is two things: I take full responsibility for managing my illness, and I chose my insightful, patient, emotionally intelligent, compassionate, husband well.
If you are suicidal or someone you know is please call Lifeline 13 11 14 immediately, and then make an urgent appointment with your primary mental health care provider.
Sick Not Selfish – for more on why suicide is almost never selfish
Radio Interview – my interview on ABC radio’s Conversations
Making Sense Of It – coming to terms with a challenging diagnosis