Content note: This piece talks about mental illness, eating disorders, suicidal ideations, and other subjects which might be difficult or upsetting. Take care of yourself and do what you need to do. ❤
“Do you have the internet?” asked the woman on the phone, who seemed perplexed that I had actually put my cell to my ear to contact her, rather than letting my fingers do the work.
“Of course, but the web portal is really confusing and I just need you to pick a psychiatrist and then make me an appointment with them. Please.”
She sighed. I tried again, deciding there was no point in making her comfortable when I was pleading for help.
“I have bipolar and I haven’t been in treatment for like seven years and I really just need to get back on my meds and talk to someone and I can’t pick someone online so please just pick. Someone. For me. Please.”
After years of trying to hold everything together on my own—to be what I thought of as strong and capable—I could acutely feel myself beginning to unravel. At that exact moment, I couldn’t be bothered to put on airs any longer, nor could I continue to creep around the problem; I needed psychiatric care, I needed it soon, and I needed a complete stranger to help me with it.
I’d spent months flipping through the pictures of smiling faces on my insurer’s database, trying to find a psychiatrist who had the small “Accepting New Patients” light in the corner of their page and who seemed like someone I could talk to. I’d made several calls, only to be told that the person was not, in fact, accepting new patients, or that they were booked months in advance.
Every time, I was more defeated than the last. Every time, I became more convinced that the seemingly-simple task of finding a medical professional to help me get the medication that I knew I needed was a fool’s errand.
Maybe I would just never get help again.
Maybe I would have to white-knuckle it through the peaks and valleys of my mood disorder with the assistance of alcohol, work, exercise, and my other various coping mechanisms.
Maybe this was just it for me — this is just how it would be.
Maybe this just was me.
“Ok, let’s see what we can do,” she chirped.
Before she would even consider booking an appointment for me, though, the woman on the phone had to ask me two questions:
- Had I been feeling as though I would prefer to simply not exist, or as though life was not worth living? And,
- Did I have any thoughts of hurting myself?
This is not the first time I’ve been asked these questions; anyone who’s ever received any kind of mental health treatment has had to answer them. And most of us have probably lied at least once in an attempt to save face.
On more than one occasion I’d given a flat, incorrect “no.” There are a lot of reasons for this, but mostly it’s just very difficult to say, out loud, to another human: Yes, I have wanted to die. Yes, I have hurt myself. Yes, I have made a plan to remove myself from this life. Yes, I have tried and failed.
It’s more difficult to say those things than it is to live with the reality. But not this time. This time, I was honest. And it seemed to work.
“Ok, do you have a preference? Male or female?” she asked, typing as she asked.
“No, I just want literally the soonest appointment you can get.”
“I can get you in today at 1pm,” she finally answered.
“Great, book it,” I said. And just like that, it was handled.
It was simple, relatively speaking, but even making the phone call left me feeling like I’d swam the length of the Columbia River. Though maybe the exhaustion wasn’t the result of the phone call itself, but rather, the circumstances that led up to it.
A month before, I began spending too much money on things I didn’t really need. I found myself vacuuming my small apartment at 3am. Too many nights, I ordered another round that I really should not have at an hour that was much too late. I said yes to every project that came to me. I double- and triple-booked my calendar. I kept losing things and forgetting details. Did I lock the front door? Did I leave the flat-iron on? Where are my keys, my hat, my scarf?
But staying up late and taking on impossible tasks felt like a much-needed holiday after the last winter, when I was walking home from work and not-so-secretly hoping I would be involved in a traffic accident, or when I was Googling which prescription medications are most effective at ending a life.
When we talk about mental illness — and, as a result, everything that goes with it, from gun violence (always blamed on mental illness) to poverty to Donald Trump — we easily, casually apply a simple solution: Mental health care. To hear advocates, pundits, and dinner table conversations tell it, the woes of the entire country could be healed with a mental health care system that actually worked. Mental health care can save us all; it saves the “regular” people from the people like me, and it saves the people like me from ourselves.
And it’s true that the safety net is a pitiably weak mesh that serves few of the people who need it the most. But it’s also true that simply having a robust and well-funded system will do nothing if the barriers to access for everyone remain insurmountable, and if the act of getting help remains highly politicized, stigmatized, and deeply shameful.
According to the National Alliance on Mental Illness, a full 50% of the one in five people who live with a mental illness are not receiving care, in large part because it is difficult to access and difficult to stick with.
Mental health care isn’t like putting aloe on a burn; it’s neither fast-acting nor simple. It’s also not cheap, not easy to make time for, and generally, not convenient. And even when it is readily available — when, like in my case, it’s literally a four-minute phone call away — actually wrapping your fingers around it and pulling it close to you is difficult. It can feel impossible.
“You should see someone,” we tell each eachother.
“If only there was better mental health care in this country,” we say after yet another great disaster wrought by a person who is deemed unstable.
As if it were that easy.
Getting health care wasn’t easy; I was a freelancer before the Affordable Care Act and the math didn’t add up to buy my own insurance. For five years, I was completely uninsured, paying for contact lenses out of pocket and receiving free reproductive health care through an absolutely essential Washington program called Take Charge. Even taking on full-time work wasn’t a guarantee that I’d be able to afford care; the $200 co-pay for visits to a mental health professional under my job’s plan felt overwhelming. It wasn’t until I was reliably employed in my late 20s that I had a plan that made access to mental health care affordable.
Dragging myself to the appointment and being radically honest with the doctor certainly wasn’t easy. In previous attempts at therapy and psychiatry, I was persistently overwhelmed with the panic of telling the truth about what was the matter with me.
Going through the process of examining myself through therapy and psychiatry has also not been easy. It’s a messy process and it’s frightening. I’ve often described it to friends like coming home from a trip with a full suitcase of dirty laundry; it’s easier and neater to leave it packed up in the corner, but eventually you’ll have to open it, take everything out, and deal with it.
But it’s easier. Easier than living without, anyway. Which I didn’t know it would be. And that is, I think, one of the biggest holes in the stories we tell about mental health and getting well: Though it is difficult to treat personality disorders, mood disorders, and other mental health conditions, it is not impossible and yes, you can feel better.
You can feel better. It won’t be easy, but doesn’t have to be this hard.
As I look critically at my early life, it’s clear that the symptoms of my bipolar disorder began making themselves apparent when I was in high school. School nights spent pacing my bedroom, electric and scattered, alternated with a kind crushing sadness I couldn’t define. Seventeen had never run a feature on mental illness and I didn’t even really know what it was or how it looked, so I’d assumed it was normal. Everyone feels like this sometimes. Life is difficult.
In college, though, it was more apparent; sophomore year, I became consumed by an eating disorder which had dogged me since I was a tween, but had now grown into a fully-fledged beast. It heightened my highs and compressed my lows. My body — small and weak and rapidly disappearing — became the conduit for everything that was the matter in my brain.
My college boyfriend began to see a therapist on campus and recommended that I do the same. I made a phone call, booked an appointment. That time it was very easy because I didn’t know what to be afraid of yet. I didn’t know how any of it worked. I just wanted to be better.
Having a first experience with mental health treatment in college is common; universities are struggling to keep up with the demand for mental health treatment on campuses, as an inexplicable uptick guides young people into their health and wellness centers in droves.
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Maybe it’s because on campus, you don’t have to navigate the vexing maze of healthcare providers. Maybe it’s because that’s when the symptoms of mood disorders tend to become most apparent. Maybe it’s generational.
For whatever the reason, college is where a lot of us first get help. Unfortunately, it’s also the last time a lot of us get help, too.
After one meeting wherein my therapist told me that I “looked like a very sad, sick person” (which was, in some way, the most melodious thing I’d ever heard; finally, someone saw me), she referred me to a nurse practitioner. And so began the Great Medication Experiment, a months-long investigation into how we could game my brain into working properly.
Most anyone who’s sought help for their mental illness can tell you about this part. Whenever we find another, we usually compare notes. What did you take? Yes, me too! Oh, I hated that one. We can rattle off our medical history, naming pills and doses like towns we passed through on the freeway to get here.
Here’s my map.
First there was Effexor, a drug which, at the time, had no generic option and was prohibitively expensive. Fortunately, my nurse practitioner said, clicking an Effexor pen and writing the prescription notes on an Effexor tablet, pharmaceutical reps gave lots of samples to the school, so I could just take samples for the time being.
Effexor’s generic name — there is one now — is venlafaxine HCl and it is used to treat depression, specifically. Unfortunately, a 2015 study found that in some patients, Effexor can actually worsen symptoms of mania. In 2007, I didn’t need a study to tell me that; I continued to lose weight, stay up all night, and make questionable decisions about my health and safety for months.
As I vibrated into my nurse practitioner’s office after Christmas break, it was apparent that the Effexor was not helping.
Next we tried Lamictal, which I loathed; it made me feel like I was underwater. I began to gain weight again, suddenly incapable of controlling my body. My face broke out. I still felt crazy, but this time in a different way. A sluggish way. And at $80 per month, the drug would never be sustainable.
Intrigued by its low price (about $7 per month) and my waning patience, my nurse practitioner decided that lithium would be a good next attempt.
A salt that’s mined straight from the earth, lithium is a somewhat mysterious drug — prescribed for bipolar disorder since the 1970s, scientists are still trying to figure out precisely how it works. What is clear, though, is that it’s dirt-cheap and, for a lot of patients, wonderfully effective.
After months of feeling like my body was the scene of a crime that kept occurring and years of holding so tightly to Being Ok, something shifted, constricted, and then ebbed away. I proceeded to take the lithium twice a day for two years, feeling a little bit blunted emotionally but also feeling, mercifully, relieved.
Until I graduated from college and lost my health care. Forcibly weaned off the drug I’d been reliant on, I began a new habit: Convincing myself I was fine.
An intriguing thing happens when you finally find the medication that helps calm the squall in your brain, which is that you no longer feel the extreme emotions you’re used to trying desperately to hold in — but you remember them. You know how it feels to be so low or to be so high or to be so intense, but you can’t quite get there anymore. They’re locked away somewhere, safely, to be examined with a clinical eye.
Following my first meeting with my psychiatrist this year, I walked out with another prescription for lithium and a feeling of accomplishment. After seven years of trying to live without it — of trying to just grit my teeth and do it alone — I felt calm and cared for.
That was several months ago. Since my first appointment, I’ve added two other drugs to my daily regimen. Every day, I take one pill in the morning and three at night. This combination helps individual aspects of my mood and personality while soothing the symptoms of ADHD, which I also live with.
For a long time, I told myself that as long as I was functioning, I was fine. So long as I was on top of it all—I wasn’t blowing deadlines or missing work or disappointing friends or failing to pay my bills—there was no problem.
Breaking down in tears in the privacy of my home every night? Lying on the floor and hoping the ceiling would cave in on me? Picking up extra writing assignments to pay for things I’d buy that I wouldn’t need when I couldn’t sleep? These behaviors weren’t ideal, but I saw them as a cost of doing business.
The amount of effort it took to retain my grasp on “fine” was exhausting and left me with precious little energy. I was always tired not because I had been doing much, but because I had been fighting so hard.
I don’t have to fight so hard now. And it’s nice.
There’s other work now, though; how much of me is my mental illness and how much of it is me. How many of my behaviors, quirks, and even attributes are because of the faulty wiring? Am I stronger for it, or better without it? Am I ready to let go of the parts of mental illness that we fetishize?
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It took me at least three tries in the last seven years to get back into treatment for my mental illness. It took several running starts, a lot of phone calls that ended in tears and frustration, and even several meetings with therapists who just were not right. It also took a lot of bad days. And it’s still not perfect; my medications come with side-effects that are distractingly apparent. But it’s better.
In that way, getting help is a little bit like dating — it’s hard to find someone who’s a good fit and, one too many bad dates (or therapy sessions) and it’s enough to decide you’re better off alone.
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The barren truth is that mental health care — finding it, getting it, taking part in it, complying with it — is work. It’s labor. It’s hard for high-functioning mentally ill people like me, and it’s impossible for those who aren’t functioning quite so well. For millions of people without health care (which was me for a lot of years), it’s simply inaccessible. As the President-elect weighs fully repealing the ACA, I wonder if he understands how many people will not only lose their healthcare, but likely, lose their life.
I suspect he does not. I suspect he does not care.
I know exactly why I waited so long to treat my mental illness. I also kn0w that I don’t intend to do it again, ever, if I can help it. And I know that in this political climate, there’s a very real chance I will.