This is What I Mean When I Talk About “Getting Help”
Content warning: Discussions about depression, anxiety and suicidal ideation.
Note: For different people, mental illness manifests itself differently. By no means is my experience meant to encompass or overshadow the experiences of others.
While I didn’t have the lexicon at the time to express myself, looking back, it was clear that I had some sort of chemical imbalance in my brain well before I was in high school. Multiple diaries, journals and discarded blogs all over the internet stand testament to the constant melancholy I was under, but it was never to the extent that I couldn’t handle it. It was never “bad enough”.
But when I was in my first year of university, things got “bad enough” and certain life circumstances out of my control (as life circumstances usually are) led to me contacting my university’s counselling and psychological services for “help”. I received an appointment for a 15-minute phone assessment two weeks later.
First year was marked by a lot of avoidance, mostly because avoiding things was one of the few coping mechanisms I had available to me. I avoided common areas and spaces around my residence that made me anxious because of how unsafe I felt. I stayed in bed and avoided my classes because of stress. I avoided contact with my friends and family. I oscillated between periods of intense sadness and intense nothingness. By February, I made the decision to drop from a full course load because of the stress I was going through.
Prior to my phone assessment, I remember writing down a list of concerns that I wanted to go through, hoping to receive some kind of care. Instead, tucked away in my dorm room, I had my assessment over the phone and spoke to someone who seemed to be reading from a list of generic questions about my well-being and general disposition.
By the end of my phone assessment, the person I was speaking to dismissively concluded that my condition didn’t seem “too bad”. They hung up on me shortly thereafter, advising me to call 911 or the emergency hotline if I was debating suicide at any point or needed immediate care.
I remember thinking to myself in disbelief, if what I was going through wasn’t “too bad”, then when would they be bad enough to merit attention?
It wasn’t until three months after that initial assessment that I received some sort of follow-up from my university. But by that time, it was exam season, and I was already so fed up and stressed out with everything else that I didn’t have the time or energy to bother going through with it.
By the time I was in third year, I was experiencing regular, consistent depressive episodes that were preventing me from doing the things I wanted to do. Thus, I decided to try and book another consultation with my university’s health and wellness services before I fell too deep into another one. The soonest available appointment was in a month’s time, and once again, I was left in a state of limbo while I waited.
In some ways, disease does not exist until we have agreed that it does, by perceiving, naming and responding to it. — Charles Rosenberg.
After a long and tiring month of midterms and waiting, I was seen by a nurse and afterwards, I was administered a computer-based questionnaire: It was about 20 questions long, multiple choice, and not dissimilar to the ones I’ve seen online when I was gauging the severity of my symptoms.
Afterwards, I spoke to another physician, who confirmed the results of the test and gave me a concrete diagnosis. My mental illness was “legitimate”. Unlike my first attempt with counselling services, she was validating. She said that anything I’ve been going through are signs of the “disorder” rather than of myself.
However, trying to pinpoint symptoms of depression and anxiety is difficult when you’ve suffered from chronically low moods and anxiety attacks for the greater portion of your life. It is difficult to separate where my personality ends, and where the ~disorders~ begin.
Because of this, I spent (and still spend) a lot of time fighting monologues of internalized sanism while coping with my mental illnesses: Am I lazy? Am I trying hard enough? I had a good day today — maybe I’m not so sick after all? Am I overreacting or am I really so severely incapacitated today that I legitimately cannot do this simple task? Are my symptoms bad enough now to merit attention?
When I was first prescribed anti-depressants/mood-stabilizers, I thought I would be getting better. I went to the closest pharmacist by myself and was warned that the risks of suicide were much greater for people my age when they first start taking them, because while my motivation to do things might return within the first few weeks, the suicidal thoughts may not yet disappear.
While many people discuss mental illness, taking medication has a stigma of its own. Because of this, I decided not to disclose anything to anyone aside from a handful of people, and constantly googled every single side effect I experienced to see if anyone had common experiences, and to see if weathering through them would be worth it in the end.
The first day I took them, I remember waking up to a strange, unfamiliar feeling of euphoria.
Everything was hilarious. Until it wasn’t, and I was hit by one of the worst anxiety attacks I had in the longest time in the middle of a crowded train. Over the next few weeks, I felt heavily sedated. My brain felt foggy. My hand-eye coordination was off and I was clumsier than my normal baseline of clumsy. Trying to finish final papers, study for midterms and exams and keep up with my schoolwork in general, on top of only having a handful of people know for support, made for an incredibly difficult adjustment period.
When I first started cognitive behavioural therapy, I thought I would be getting better. I was learning how to better manage negative thoughts. I attended weekly sessions and read articles online. I sought to do the opposite behaviour of what I wanted to do/had the energy to do in order to introduce breaks into the positive feedback loop of depression — I tried my best to consistently get myself out of bed, I went out on days I didn’t really want to, I forced myself to eat on the days when I didn’t have any appetite, I kept a happy book, I made conversation with people around me, I exercised.
When I first started individual psychotherapy, I thought would be getting better. I thought I was making progress, but the next session thereafter, my therapist forgot about what I disclosed the session before. People are human and sometimes this happens, but I wished this didn’t happen to me.
If this is the best “help” that can be offered, then we need to do better.
While my attempts to get help were not the most straightforward, I also benefited from having a considerable amount of privilege: The costs of seeing several health care professionals and getting medication were covered by my parents’ health insurance. My class schedule allowed for me to schedule appointments and attend sessions that only ran during certain times of the week, i.e. weekdays during regular business hours. I am no longer a minor and thus was able to take control of my healthcare without having to have first seek the consent of my parents. And despite having grown up in an Asian household — where the language for mental illness simply doesn’t exist outside of an Anglicization for different mental conditions, or is often normalized and even praised as the result of being hard-working — my family has been incredibly accepting and validating.
However, the populations most vulnerable for mental illness often don’t have these privileges and are often hit even harder by mental illness because of the intersecting levels of oppression that they face.
Aside from the barriers that prevent people from even accessing the care they need, there are interpersonal barriers that arise that can prevent someone from getting the care appropriate for their specific circumstances. In an ideal world, health care professionals are free from their own personal biases and prejudices, or at the very least, ensure that these personal biases don’t interfere with their giving of care.
Unfortunately, this isn’t always the case, and the result of seeking help from these institutions can often cause more harm than good. This is especially true when you examine the paradigms of patient care from which medical education historically stems, which center models of the body and narratives of cisheterosexual able-bodied white men. This is not representative of the diverse populations found within communities and fails to takes into consideration the viewpoints of marginalized populations, and can lead to feelings of “othering” and misunderstandings in the process of trying to receive care.
While I applaud many student-run organizations and community-level organizations for taking the responsibility to fill in the gaps, to create support groups and safe spaces for students whose concerns aren’t being properly addressed by health care institutions, it is worth considering that doing so also absolves universities from taking on that responsibility themselves. Universities should be equipping their staff with equity and diversity training in order to properly help students who have intersecting levels of oppression that might exacerbate their mental illness. Failing to hold these institutions accountable means that the conditions that allowed students to fall through the cracks will be perpetuated in future years. It is not enough to talk about change without implementing policies that allow for institutional memory. Change must be codified into actual policy that can be carried out to create the change we wish to see.
Alternatively, some do believe that there are a wide range of resources available for students offered by the university themselves. However, even if universities boast a wide range of resources available for students, ill-coordinated referrals between offices and long waits can make for a tiring process that make students doubt whether or not it is worth pursuing care.
Despite the integration of my university’s Counselling and Psychological Services with the general Health & Wellness office, the transfer of medical records was not. As a result, since I’ve started “seeking help”, I have probably spoken to around eight different health-care professionals: A triage nurse, two general practitioners, a psychiatrist, a social worker, a therapist, a pharmacist, a psychologist and a disability counselor. For several of these encounters, I had to independently seek assistance from separate offices across campus rather than having a streamlined referral process where someone could advocate or relay my concerns on my behalf.
This doesn’t even include the online correspondence I’ve had to take to deal with acquiring academic accommodations from my registrar and my professors. Above all, I’ve been “assessed” for my mental condition with some variation of a diagnostic questionnaire on four separate occasions, even after I had been given an “official” diagnosis. This is not okay.
Having to talk to complete strangers, gauge whether or not they would be judgmental of you or whether they would be a safe person to open up to, and having to repeat yourself over and over and over again just to have your diagnosis and your conditions realized, is tiring. Having to advocate for yourself to have your illness legitimized, when the majority of your symptoms prevent you from having the energy to do so, is tiring. Having to attend appointment after appointment on top of managing your other responsibilities, is exhausting.
A lot of people simplify the narrative about getting help to a single line sentence, when in reality, my experience with trying to get the help that best suits me and my needs has been incredibly difficult, despite my acknowledgement over the privilege that I have.
Recovery has been difficult, and I think it is easy to conflate getting help with recovery, but one does not always lead to the other. I have dealt with mental illness for a long time, and I have come to accept that despite my best efforts, I don’t think it will go away. A lot of symptoms are episodic; some days, it feels like they go on vacation. I’m able to do the things I want to do without having to deal with deal with the annoying symptoms of depression and anxiety, and sometimes I forget that I am ill to begin with. But some days are harder than others, and on those days, even my best efforts won’t look that great, but I have to learn to accept that these are the limitations that I have.
It is very easy to dismiss mental illness and depersonalize it. To talk to people with mental illness rather than to talk with them and create a dialogue that includes their needs and prioritizes their views. To do so and realize that at the end of the day, they may still not walk away feeling better, is incredibly, incredibly hard.
In contrast, it is easy to suggest solutions and try to cheer people up because dealing with uncomfortable, terrible, heartbreaking narratives of mental illness that don’t involve rainbows and sunshine and puppies and positivity is difficult to stomach.
It is easy to suggest solutions, even when someone isn’t really asking for one. It is harder to sit there and listen and empathize with them. But I think this is something we need to start moving towards doing. It is harder to sit there with them and empathize, especially when you realize how difficult it is to truly gain an understanding of what they are going through without minimizing their narrative.
But I think it is worth a try.