Major Depressive Disorder. Bipolar Disorders. Autism Spectrum Disorder. Attention Deficit/Hyperactivity Disorder. Schizophrenia. Anxiety Disorders. Obsessive Compulsive Disorder. Post Traumatic Stress Disorder. Anorexia Nervosa. Bulemia Nervosa. All of these labels come with a diagnostic code and they are all defined in the DSM V, The Diagnostic and Statistical Manual of Mental Disorders; the book that is the mental health professional's bible.
Yesterday, along with an intern, I treated a woman who clearly met the diagnostic criteria for MDD (major depressive disorder). She was adamant that she would not go to see either a psychiatrist or any other mental health provider. No amount of coaxing was going to convince her that she might benefit from talking to a trained, objective 3rd party. We finally compromised and agreed to start medication and she would return in 2 weeks to evaluate the effects of the medication and at that time we'd discuss therapy some more.
I'm going to out myself here. I've had the same mental health provider for almost 20 years. At times we've seen each other more frequently than other times; during and after pregnancies, major home renovations and treatment for breast cancer we saw a lot of each other. Now, I talk to her monthly whether I "need" it or not. I've decided that mental health maintenance is important for me and my family and the annual cost far outweighs any future cost from not going. Am I crazy? Aren't we all a little bit? I'll tell you one thing, after 20+ years of therapy I'm far less crazy than I might have been without it. Throughout the course of our relationship, this woman, who is an angel from God himself and like a second mother to me, has never told me what to think or given me the answers but she has listened and in listening she's helped me analyze situations and relationships clearly.
I first sought out help from mental health providers in medical school when I was clinically depressed. I had all of the symptoms, sleeplessness, anhedonia, decreased appetite, depressed mood, feelings of guilt and worthlessness. The scariest part was the suicidal thoughts that I was having. I never actually attempted suicide, but I had come up with several scenarios. You see, at this time, the pain was unbearable. There was no rationale explanation for my depression. I knew that my family would suffer but many times I thought this was the only way to escape the pain that I was feeling and to stop some of my destructive behaviors. I felt embarrassed about the way my brain was working, I felt defective and I didn't think anyone could help me. At that time I became friends with one of my clinical rotation partners and she was one person who couldn't see me through the same filter in which I was viewing myself. When you are depressed, the reflection you see is warped, like a funhouse mirror. Finally I mustered the courage to ask my primary care doctor for the name of a therapist. She gave me a list of names and I randomly picked a number and called.
Robin Williams' death is a tragedy. He was well loved and his legacy will endure through his family and his body of work. The conversation that needs to occur through all of this is that mental health disorders are real and they are treatable. No one chooses depression or autism or schizophrenia or bipolar just as no one chooses diabetes or cancer or asthma or heart disease. Mental health disorders are not a weakness or flaw in character. They are biologic disorders that need recognition and treatment. All this energy that we are spending remembering Robin Williams can be shifted towards education and ridding our society of any stigma that may be associated with mental health disorders. Would you judge someone for having leukemia? Would you tell your family member to avoid medications to treat their high blood pressure? Yes, we can honor Robin Williams but in doing so lets make mental health awareness a thing, a ribbon, a month...Suicide is a manifestation of an illness. People who commit suicide are sick in the same way someone with congestive heart failure is sick, it's just a different organ system. If you were feeling short of breath you'd call a doctor. If you had a fever that won't go away, you'd call a doctor. If you have sadness or mania or anxiety or any other brain based symptom and it won't go away, call a doctor! It's not shameful to have the symptoms or to make the call. What would be a shame is to let the symptoms go unrecognized or untreated. If you have a loved one and they have brain based symptoms, talk to them about it and don't judge. Identify the signs that you might be witnessing and encourage treatment. If your brother or sister or cousin or friend had a disfiguring rash that won't go away, you'd eventually bring it up and take them to the dermatologist or urgent care center or ER or make them seek treatment. Brain based symptoms can be just as disfiguring, altering the individual that you know.
My cousin committed suicide 13 years ago, August 8th 2001. I don't have any sisters so my step-sister and my female cousins are the next best thing. My cousin was 4 years younger than me, but we had spent many summers together and when I moved to Texas for medical school she was starting college and our worlds started colliding more and more. Austin and Houston are only 2 and a half hours apart so we'd see each other frequently and I was able to see her go through those late adolescent stages of individuation as she challenged traditional values and tried on different view points and ideas. In the summer of 1994 she and I both spent a lot of time together in Mexico in Oaxaca and Cancun. She and I were both dating boys that we liked and were in the same early stages of like in our respective relationships. I heard a lot about her future husband and she heard a lot about the boy that I dumped for my future husband. We were become adults at the same time. We were in the same cohort and we were thinking about careers and weddings and marriage and kids and mental health. She was bipolar and had a lot of anxiety and I had major depression. We both got it.
I'll never forget that day and that phone call. It is permanently etched in my mind. The days that followed seemed like I was floating through an alternate universe. The air was thick and I was moving through mud. She wasn't my sister or my daughter, but she was the next closest thing and most days I think about her and what life might have been like if she had traveled along a different trajectory. She left a giant hole in my life and in the life of so many others. It's a hole that can never be filled and at times is more gaping than others. Right now is one of those times. It's like a scab has been ripped right off and the wound is fresh again, except this time the scab covers the majority of the body. The wound feels deeper, more sensitive and the salt is raining down. Her younger and only sister, has been vocal about her anger at the romanticization of Robin Williams. It's not anger at the man but there is anger towards the action. Those of us who survive suicide have to relive the horrors and lasso the demons frequently and unexpectedly. This time it's different; it's in your face and it's everywhere. Every magazine, every radio DJ, every online article, every movie on TV....everywhere...it's all about remembering this individual. That is fine. I remember my cousin everyday in lots of little ways. It's vital to remember her and talk about her and tell stories about her. Last night when I was floating in my pool, looking up at the stars after I had exorcised and exercised out my hurt and pain and anger, I thought about heaven and I thought about who I was most excited to see and I know my cousin can't wait, in time, to see all of us. It will be the best encuentro ever.
We talk about everything in our family of five. Nothing is off limits. My kids know about my cousin and they know about suicide and death and all sorts of uncomfortable topics. They know that I talk to my psychiatrist, my second mom, once a month. All the news and media coverage has brought up lots of conversations. I'm grateful for sunglasses and exercise and God and my Bible and the ability to write down my thoughts. This is not an easy time and it will get easier. In the mean time I'll honor my cousin and all others by knowing its okay to address mental health and brain based symptoms. There is no reason to fear the conversations or the acknowledgement. Talk to someone. Talk about it.
American Foundation for Suicide Prevention
www.afsp.org
National Suicide Prevention Lifeline
www.suicidepreventionlifeline.org
National Alliance on Mental Illness
www.nami.org