Semicolons and Blank Spaces

Disclaimer: I am not a mental health professional. I am not certified to give medical advice. If you’re thinking about the possibility of suicide or consider it an option, I encourage you to reach out to a mental health professional or go here.

A month ago, I wouldn’t have recognized Amy Bleuel’s name. I knew of the semicolon tattoo, and had a vague idea that it started as a kind of social movement to support people with mental illness.

I don’t have a semicolon tattoo. I don’t have any tattoos, due to some combination of an aversion to markings on my skin (bar stamps drive me crazy), an awareness of my own fickle tastes and how a design with significance now could mean nothing after a month, and a general fear of doing anything outside my comfort zone. I like the idea an unobtrusive tattoo with emotional significance, but if I were to get one I would probably choose something with a more personal meaning.

When I first read the news of Amy’s death, my first reaction was something like what this article seems to be anticipating: a sense of betrayal, of being let down. Amy meant nothing to me beyond the concept of her tattoo, but hearing that she had taken her own life made me feel personally cheated. Could we really trust an anti-suicide activist who had chosen to take her own life? As tragic as her story is, didn’t it also make her a fraud? A hypocrite?

Well, no, not really. I quickly realized those thoughts were irrational. But I still felt them, and apparently so did other people. So the question I put to myself is: why? Why would an anti-suicide activist’s suicide make me think of her as a hypocrite? If that was my first thought upon reading the story, then isn’t there something fundamentally wrong about my assumptions?

I can’t unravel that question entirely. But this is the answer that makes sense to me in the context of my experience of depression, anxiety, and suicidal ideation over the last 14 years.

One of the problems with the way we talk about suicide is that it requires the internal experience of mental illness to be preformed in an external and in some sense public act. In order for mental illness to be “real,” it has to have effects outside of us.

It’s common to dismiss a suicide or an attempted suicide as a “cry for help,” and while this is a reductionist explanation, there is still something to it. Many times over the years, I’ve wondered if the way to get people to take my suffering “seriously” was to attempt suicide. Doctors, therapists, and people in school and work contexts talk about mental health “emergencies” but they only ever mean suicide attempts. I’ve had plenty of mental and emotional “emergencies,” times I felt so low or so panicked that I was desperate for some kind of clinical intervention. Once, I drove myself to the emergency room in the middle of the night. The shot of anti-anxiety medication helped, but what I really needed was to do something, to take a physical action commensurate with my internal state.

No matter how many doctors deliver diagnoses, no matter how many copies of the DSM-V are printed and consulted, no matter how many associations of doctors make formal pronouncements, mental illness is, and always be, an internal phenomenon. Thoughts, feelings, and physical sensations: no matter how intense or overpowering they are, they cannot be externally measured. They must always be reported to be addressed.

This is, of course, a problem for those who want to treat mental illness, from medical doctors down to friends and loved ones. But what gets less attention is how much this is a problem for actual sufferers of mental illness. It isn’t just that they need other people to recognize their illness; we ourselves face a ceaseless struggle to recognize our illness for what it is, instead of what it appears to us to be — reality.


Mental illness is perspectival, in philosophical terms, epistemological. Depressed people don’t just feel hopeless; they believe that their circumstances logically compel hopelessness as the only appropriate response to their circumstances. Anxious people don’t just experience anxiety; they are anxious because they perceive themselves to be in imminent, overwhelming danger, and thus they act and feel the way any rational person would in those circumstances. Coming to terms with your own mental illness means, to one degree or another, acknowledging and living with the fact that you can’t trust your own brain.

And yet we have to keep living. We have rely on our brain for so many other things, and in so many ways, it comes through for us. The patterns of thought that drive our illness are not in a separate compartment of our minds but are mixed in with or even identical to the ways of thinking that serve us so well in other respects. The process of disentangling the ways of seeing the world that keep us alive and happy and the ones that destroy us from the inside is a struggle that takes years or lifetimes. The the most basic struggle of recovery is not dealing with our mental and emotional problems; it’s remembering, day by day and moment by moment, that we have those problems in the first place.

People who have sought treatment, who have received a diagnosis, who take pills and visit therapists, still struggle to see their illness as real. As quick as they may be to admit their diagnosis, by virtue of being mentally ill, they are in a constant fight to understand that diagnosis as identifying their perception as the problem and not reality. That’s why the external markers of illness become so important to us. A formal diagnosis, a regular visit to the doctor, a daily medication: they all have a dimension of performance, of demonstrating an internal reality in a physical way.

This struck me other day when I was reading a web comic comparing people who casually claim that they have a mental illness (e.g. “Oh my god, I am so bipolar!”) to people who actually do. The panel with the example of someone who is “actually” depressed had an image of someone still in bed in the middle of the day. I didn’t think much of it, until the though struck me later: You’re not really depressed. If you were really depressed, you’d be skipping work and hiding in your bedroom all day.

Thankfully, I’m at a place where I was able to recognize how ridiculous that thought was as soon as it occurred to me. But at another time in my life, I may not have been able to. It reflects an underlying assumption that I can’t shake: for my depression to be “real,” it has to produce something. There has to be something that can be seen, noted, measured, analyzed — not just by someone else, but by me. I need validation that my own internal experiences are abnormal and worthy of attention, because to me, they’re just my experiences, different in intensity but not in kind from everything else I experience on a moment-by-moment basis.

In my own experience, the idea of suicide works the same way. Suicide, or a suicide attempt, would not just be a cry for help directed at others. It would be an enactment, a way to affirm in a tangible and (eventually) public way that what is inside me is real. It allows me to act, to have agency as a human being and not just a sufferer.

Every mentally ill person knows the experience of acting happy when they are dead inside, of keeping it together when they’re falling apart. Surviving on a day-to-day basis as a person with mental illness means constantly hiding the truth. The degree to which we’re forced, or feel we’re forced, to hide our symptoms is the degree to which we are not allowing our internal perception of reality to be confronted by something objective. The better we get at convincing people that we’re experiencing the same reality, the better we get at convincing ourselves of the same thing. But we’re not, and the reality our brains create for us is enough to kill us.

If Amy Bleuel’s experience was anything like mine, she took her own life because she was facing something massively, enormously difficult, something impossible. She was experiencing pain more than a human being should have to bear, more than a human being can bear. Her mind created a world for her in which suicide was a rational option, and she took it.

I know it’s scary to talk about suicide as “rational,” and I’m not quite comfortable with it myself. Maybe it’s dangerous to talk that way. But it shouldn’t be. Suicide can be a rational response to a false understanding of reality. We have to devote resources not just to stop the act of suicide but to counteract the false view of reality that make the act an option.

The problem with my instinctive response to Amy’s death, and of people to mental illness in general, and of my own response to my own mental illness, is an unwillingness to ascribe “realness” to what occurs inside people. Really, it’s a general unwillingness on our part to truly empathize, to come to take seriously feelings and thoughts for whose existence we can only take others’ word. But the severity and the consequences of mental illness make this problem even more acute.

If we’re going to treat mental illness, in others or in ourselves, we have to acknowledge that mental illness is both real and unreal: real in the sense that it isn’t transient like everyday emotions or dependent on circumstances, and unreal in the sense that it represents a false interpretation of reality. If false beliefs have real consequences, then the first step toward addressing the beliefs is treating the consequences as real.


That’s where empathy comes in. Depression, anxiety, compulsion cannot be seen or measured, and it takes an act of compassion and imagination to affirm their reality, both from sufferers and for their loved ones. Whether I’m attempting to imagine the suffering that Amy must have been enduring or recognizing my that my own feelings and impulses aren’t natural responses to my life situation, it’s an effort, an act, work. It’s always easier understand fear that has a real justification or sadness that has a recognizable cause. But if the pain and anguish aren’t acknowledged for what they are — products of a false perception — then the false perception itself will only be perpetuated.

Suffering that just happens, that has no discernible cause, is massively frustrating for everyone. We and our loved ones want pain that can be analyzed and addressed, because otherwise we’re helpless to do anything about it. Maybe that’s the biggest reason we’re tempted to dismiss it, because we don’t have the time or energy to deal with problems, whether others or our own, that have no apparent solution.

That’s the reality, and at the end of the day, we’re only human. There’s only so much we can do. But we can always do a little bit better. We have to, because lives are at stake.

If I have to spend my whole life justifying and explaining pain that has no justification or explanation, pretending that my own thoughts and feelings accord with the same reality that others experience, I’m not going to make it. None of us are.

We need to love and accept ourselves. We need to love and accept each other. We need to exercise the imagination required to recognize the kind of pain that has no obvious source.

Once we isolate that pain, once we see it as it is, we can begin the process of reacquainting ourselves with what’s real. We can make ourselves face a world that accord with our internal rules and assumptions about how it must work. We can love and serve and support people in ways that challenge their beliefs about who they are and what they deserve. We can fight every day for ourselves and the people we love.

This is a war. Some of us aren’t going to make it — not because of our own weaknesses, but because of the magnitude of what we’re attempting. The odds are against us. They always are.

Let’s not go down without a fight.

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