Content note: mental health, mention of eating disorders, stigma.
For anybody who’s spent more than one term at this university, the message that ‘we have to tackle the stigma surrounding mental health’ will be familiar. Talking about mental health problems is vital, and as long as any sufferer feels worried, awkward or ashamed about the issues they are facing, it is a message that we need to repeat. Yet, if this phrase is to mean anything, we have to actually think seriously about what the process of de-stigmatisation entails. It’s also incumbent upon us to recognise that the decision to speak to somebody, to reach out, is not the end of the line. Seeking support, be it from friends or professionals, is too often, at least implicitly, portrayed as the ‘happily ever after’ ending to the mental health story. It isn’t. It’s just the start of a bumpy ride for all concerned. Opening up is a crucial stage in learning to live with our demons, but if we want to actually help people recover we also have to be honest about the fact that talking is not easy or without problems. Friends don’t always understand. Pills won’t wipe all your problems away. That isn’t your fault. It isn’t necessarily the fault of your friends, relatives, or doctors. But it is part of the story of mental health recovery that we should admit if we truly want to remove the stigma surrounding it.
There’s a struggle even before you get to the point of talking. Who can you open up to? Many of us would ardently hope that our friends would feel confident enough to confide in us. But it’s an enormous gamble for those suffering. To be accepted, befriended, cared for, and loved by another person is an incomprehensible gift when you are convinced that you’re worthless. Opening up to a friend means considering what might go wrong in the process. It means having the audacity to face up to your own doubts and put what seems to be all that you have on the line. The fear of rejection, of putting your foot in it, the fear of being the architect of your own solitude, makes even the seemingly simple act of speaking to a friend or relative one of the hardest choices to make. And let’s not beat around the bush here: this is a gendered issue. In 2012, the male suicide rate was 3.5 times that of other genders. Regardless of gender, opening up is hard, but the data highlights a real issue.
And how do you find the words? Nothing seems appropriate. You face a real dilemma. Are lines that seem utterly clichéd the best to use if you want support? Or do you steer clear of them out of fear of not being taken seriously? And will people understand? Words, powerful as they are, cannot convey the full depth of human experience. ‘I feel empty’ will never be an adequate expression of the utter hollowness of that feeling, the mixture of numbness, sadness and apathy that seems to make even time seem torpid and lagging. Nor does ‘panic’ really express that heart pounding, dizzying anxiety that sweeps the body. Is it only you that can somehow feel both a fear of company, but a deeper fear of solitude? Trying to be understood is made so much harder when the means to explain seem so utterly inadequate.
Assuming those hurdles have been jumped, the sufferer faces a long road. Therapy and the right medication are, I would say, essential. But the process of talking to a stranger is one fraught with difficult, awkward episodes. Explaining to a professional those cognitions that seem to you to be pathetically self-pitying is uncomfortable. Revisiting difficult episodes and thoughts on a regular basis can be embarrassing and painful as much as helpful. And there’s no guarantee you’ll find the right help straight away; therapy is a personality based process, and if the relationship isn’t right it can leave you feeling patronised rather than supported. Medication can help the process, but it takes time to find the right dosage, and even then, the battle against your own thoughts is only half fought.
But, though it may seem odd, the biggest struggle of all can be with your friends. Or, more accurately, it is between you, your thoughts, and your friends. Before we go much further, it has to be iterated: they care. They really do. But that doesn’t mean it’s easy, and it doesn’t mean that it can’t go wrong. Once you’ve opened up to your friends about whatever it is that you’re facing, it can be very hard to feel secure in your relationship at times. You will constantly worry that you’re being a burden to them. And though they tell you otherwise, your brain will reason its way into convincing you that they’re benevolent liars. Christopher Lasch, whilst admittedly not the most generous of commentators on modern psychology, perfectly captured the insidious power of over-analysis to teach mistrust when he wrote that: man longs for ‘the lost innocence of spontaneous feeling. Unable to express emotion without calculating its effects on others, he doubts the authenticity of its expression in others and therefore derives little comfort from audience reactions to his own performance.’ And in the moments when you aren’t feeling great, you can do things to your friends that you’ll never forgive yourself for. I did. I do. They can be contextualised, but we know that it’s wrong, and that guilt is real, and the burden of mental health problems is made no lighter by it. They make mistakes too. There are the throw away, ill thought out comments that they might forget instantly, but you take like a barb to the heart. All it takes is a moment of understandable frustration for someone to make an accusation like ‘You’re using your eating disorder as an excuse to avoid socialising’, yet it cuts deep all the same.
Sadly, to be honest about de-stigmatisation around recovery, we also have to admit that the one thing everybody fears can happen. The world of mental health problems is not an easy one to inhabit, for either you or your friends and family. Sometimes relationships don’t survive. The danger is one of coming full circle. When you’re wrapped up in your own thoughts for too long, it’s easy to forget that those who support you also need a break, and maybe some support of their own. If people don’t get that space, things can, sadly, turn sour. Friends get frustrated. ‘Maybe you ought to think about speaking to someone better qualified?’ And though you know that they’re right, it seems like a personal failure all the same: you’ve become the burden you always knew you were. That’s a bitter realisation. Trying to rectify the situation is like trying to catch smoke. Attempting to apologise, to ask to go back to ‘normal’, you find the olive branches are a little too brittle. You might be told ‘We shouldn’t talk about that‘, that pronoun laden with a vaguely solemn dread, a seeming reminder that your concerns are abnormal, that they are problematic. The stigma has snuck back in. Constantly trying to fix a problem that it seems only you can recognise between the two of you just alienates you all the more, and the sufferer is left with just the memories of what could have been. A friendship that promised so much, that made you feel actually human and worthy, but delivered only guilt.
So, where does that leave us? Not any more cheerful, that’s for sure. I was in two minds about even writing this at all. If anything that I write were to scare people away from opening up, I would be so very sad. Recovery begins with dialogue. But equally, I cannot perpetuate the lie that talking is the end of the problem, comfortable though that lie may be. Nobody should be ashamed of having a mental health problem; it affects far too many people, and it ruins, and cuts short, too many lives. But when we talk about stigma, we need to admit that stigma doesn’t simply vanish when we begin talking about our problems. It’s a stain that takes real time, effort, and understanding to wash clean, both from those we reach out to, and ourselves. Yes, let’s talk about it, but let’s not lie. That doesn’t help things. Setting out the dangers that lurk on the road to recovery is admittedly a pessimistic way of approaching the problem, but perhaps the real message to be conveyed here is that, if we admit that it’s hard, if we recognise that things can go wrong, then we can really tackle that feeling of personal guilt head on, and hopefully prevent others from stumbling where we fell.