When I got into hockey about five years ago, it was mostly because the game itself was so interesting to me. It’s fast, it requires a ton of skill, it has a lot of “holy crap can you believe that” moments, and everyone hugs after scoring. That’s my kind of sport. But a big reason, I think, that I stayed so invested in hockey was the fact that the hockey community is so intensely invested in initiatives to de-stigmatize mental health issues. As someone who has dealt with a lot of mental health issues (anxiety, depression, ADD), has been in therapy on and off (but mostly on) for over twenty years, and has been on psychiatric medication for about 17 and a half of those years, this was an enormous weight off my shoulders. At the time I got into hockey, I was nearing the tail end of my seven year episode of being housebound due to agoraphobia, and it was such a relief to be around people I felt like I didn’t have to lie to. Not that I told everyone around me the intimate details of my mental health, or really any details at all, but the knowledge that I could, that I didn’t have to be closeted if I didn’t want to, was a huge weight off my shoulders.
Every year the hockey community (because the hockey community is largely Canadian) explodes with the hashtag #BellLetsTalk, which donates $0.05 to Canadian mental health initiatives every time it is shared on social media and also encourages the frank and open discussion of mental health issues. In the last few years, even though Bell is a Canadian company, it’s become a big thing not just in the hockey community. As of me typing this, #BellLetsTalk is also trending second in the United States. And frankly, not that many people are hockey fans.
Since today is for sharing about mental health, and since I have spent so much of my life being mentally ill and going through every type of therapy and/or medication regime there is, I thought rather than share my story (which is not very interesting – I was sick, then I worked really hard and now I’m better), I’d share the seven iron-clad mental health rules that I have learned and that I wish everyone, mentally ill or not, knew.
One: What you’re going through is “normal”.
When I was housebound, a huge part of my self-perpetuating fear was shame. I felt like I was sicker than everyone else, crazier than everyone else, and that no one else was going through the same shit I was going through. And while it’s true that seven years is an unusually long bout, what I went through, I discovered, is actually pretty normal. I lost count of how many times my mom would come home and tell me about someone I grew up with who moved back home for mental health reasons, or people who, when I told them what I was doing with my life (at that time, going to a lot of therapy), said “me too!” or “I used to do that!”
According to the National Alliance on Mental Illness, one in four adults experience mental illness in any given year. And that’s just in a year, not ever in their lifetime. About 6% of adults are like me in that they live with a “major” mental health issue such as severe depression, schizophrenia, bipolar disorder, or basically anything that doesn’t come and go the way things like panic attack disorders will, but is always there and impacts their day-to-day lives.
This means that if you live in America, there’s a good point that any given person you walk past on the street is either mentally ill or has been mentally ill at one point in their lives. There’s almost a 100% chance that every random person on the street is either mentally ill or knows and loves at least one person who is mentally ill, even if they aren’t themselves. To put this in perspective, if you add up adults who experience mental illness in any given year (that’s 61.5 million), and then added the number of kids who will experience mental health issues before the age of 18 (which is 20% of all children, which, according to the census, clocks in at around 14.7 million), and added them together, that’s about 76.2 million people. To give you an idea of how many people that is (it’s a lot), if mentally ill Americans made their own country, it would be the 20th most populous country on the planet. It would only be about a million people short of the nation of Turkey and would have more people than the entire nation of Thailand.
That’s a whole lot of mentally ill people.
Two: Tell the people around you how you feel. Teach yourself to be honest, and listen when people are being honest with you.
When I was at my worst, the thing I feared most was conversations with people I knew but didn’t know well enough to keep appraised of my everyday life, because they would inevitably start the conversation asking how I was and what I was doing with myself, and they would expect an answer besides “having panic attacks in bed and watching a lot of sitcoms on Hulu.” We are socially trained to ask people how they are, but it’s not a genuine question, it’s an automatic nicety, like commenting on a particularly lovely bout of warm weather.
Once I got better and was doing other things with my life, enough that I could say “I used to be housebound, but I’m not anymore”, I found almost without fail that had I been honest back then, everyone would have been super nice about it, because people were nice about me admitting to it. Everyone knew I was going through “a rough time finding myself” (or whatever general malaise is ascribed to millennials) , but no one knew how to help me or what to say or how to reach out because I wasn’t letting them. This is not to say that everyone was great about it – some people were real dicks, but I generally found that those people were not people I would have wanted in my life in the first place. A lot of people, once I started talking, expressed relief. My mental health was a giant elephant in the room. We all knew it was there, but we were all killing ourselves trying to pretend it wasn’t, and it made social interaction a lot harder than it had to be and a lot less enjoyable for both of us.
If people don’t know how you feel, they cannot accommodate you (and if someone loves you or cares about you, they do want to accommodate you). They cannot be understanding when you flake out of something important or are struggling to accomplish the things you need to accomplish. When people are angry because of this, it isn’t necessarily anger at you. Sometimes, it’s anger at the fact that they can’t help you, or anger that you don’t trust them enough to let them try. And if you feel like people are treating you unreasonably and expecting you to do things you simply cannot do, sometimes, yes, it’s because people are jerks. Usually it’s because they’re totally unaware you can’t do them.
And to that effect, if someone in your life is struggling with something or unable to do things they should or used to be able to do, let them know they can come to you. Let them know you are ready to listen. And if they do come to you actually listen. Do not offer advice, opinions, or instructions unless it is your job to do so or they explicitly ask you. I’m going to repeat that one more time for emphasis: DO NOT OFFER ADVICE, OPINIONS, OR INSTRUCTIONS UNLESS IT IS YOUR JOB TO DO SO OR THEY EXPLICITLY ASK YOU. Listen. Actually listen. Be sympathetic and empathetic. Re-iterate that you are there for them. Make it easy for them to reach you again.
Three: Therapy works, but only if you actually try it (and sometimes you have to try a few times).
Regardless of your mental health, if you are wondering “could I be helped by going to a therapist?” the answer is, unequivocally, yes. This applies to every single person reading this. Do you have a traumatic experience holding you back? A recurring or significant problem you cannot work through? Are you just plain old unhappy with your life but don’t know what to change or how to change it? If so, therapy will be helpful for you.
When someone asks me my advice and I suggest therapy, the reason most people who ignore that ignore it is because they say, “I went to a therapist and it didn’t work.” This is a terrible reason. A therapist isn’t like a medical doctor, they’re more like a contractor you hire to help with repairs your mental house in that you don’t go with the first one, you shop around until you find one you like. There is no one form of therapy that works for everyone because everyone’s brain is different. Before you go to a therapist, think about the types of people you get along well with and feel easy talking to and following the advice of. Are they the same gender as you, or a different gender? Are they older, younger, or around your age? What kind of demeanor do they have? Do they respond with humor, or not? Are they interactive, or more of a sounding board? Do you prefer using more cconcrete and scientific methods, or using more cerebral and off the beaten path strategies? Think about what relaxes you and helps you implicitly trust a person, and go with a therapist who has those things. Like with dating, it’s okay not to find someone perfect, but it is NOT okay to stick with someone who has a lot of dealbreakers. If you want to see a therapist about your troubled relationship with your mother, maybe don’t go to a matronly therapist, and if you’re having trouble not feeling listened to or validated, don’t go to a therapist who likes the sound of their own voice, is my point. It is more than okay to only see a therapist once and decide you don’t like them, or audition several at once – in fact, therapists expect that. And even if you have been seeing a therapist for years, it is okay to, at any time, say “you know what, I don’t think we’re making progress here” and part amicably. Again, therapists are trained to expect that and, if you’re really not making progress, they probably saw it coming. Sometimes they’ll even come out and suggest it themselves.
Finding therapists to try is pretty easy – ask around. Ask your friends who are therapists who they know who specializes in what you’re looking for (do not ever go to your friends to be your therapist, either with or without you paying them, that’s unethical). Ask your friends who go to therapists to see who their therapists know. Ask your primary care physician or any doctor you see even semi-regularly. If you are in school, your school has at least one therapist, and what’s more, that therapist will see you for free and your parents will never have to know, if that’s an issue. (Also even if you are under 18 or living with your parents, it is illegal for your therapist to tell your parents anything you tell them without your explicit permission, usually in the form of a signed waiver.) If you don’t like the first therapist you see, they should be able to refer you to a colleague. Most healthcare plans will have directories of therapists who are in network with listings of their specialties online. You can go through the American Psychological Association or the National Association of Social Workers since everyone in that profession has to register and be accredited by them (social workers and psychologists are both therapists, the difference is just in what type of degree the therapist has and what they specialize in). Honestly, if you’re at your wits’ end, use Google. Find anyone anywhere in the country who you feel you fit with, call them, and ask them to refer you to someone locally. If you really just want to feel things out in terms of therapy, there are services like 7Cups that are, essentially, free help lines, like a suicide hotline if you’re not considering committing suicide and just need someone trained in listening to talk to. It’s not a viable long-term solution or replacement for therapy, but if you’re in a crisis, it’s a great place to start.
Once you are going to a therapist you trust, you need to be honest with them and listen to their advice. I have had so many people dismiss therapy while also telling me they lied to their therapist, or refused tell their therapist about something traumatic that happened, or – and this is one I too have been guilty of – they got advice from their therapist, but they’re not gonna do it. If you have a good underlying relationship with your therapist, you need to do follow what they say because unlike you, they are trained in knowing what to do. You need to do it even if it is hard (they are there to help you with that), or even if you think you know better (you don’t, even if you are also a therapist), or you don’t want to (if you are reading this, you’re not three years old, and therefore you’ve aged out of this excuse). If you have tried and can’t do what they’re telling you, that’s okay! When you go back and see them, tell them! They’ll workshop with you! That is also part of their job.
The final thing I hear a lot is “I can’t afford therapy”. Without knowing each individual person’s financial situation (and only speaking in terms of the American healthcare system, since I don’t know how others work), I’m guessing it’s more affordable than a lot of people think. First of all, if you have insurance, you have some level of at least rudimentary mental health care. Thanks to Obamacare/The Affordable Care Act, all healthcare plans must treat mental health like they treat physical health. Period. End of discussion. This isn’t a huge help if your healthcare plan does jack shit to cover your physical health, but it’s not nothing. You can read the fun fine print here if you want to know the full legal situation.
Also, in terms of cost effectiveness, therapy is worth it. I see a more expensive therapist that I have to pay for entirely out of pocket, and I see him twice a month. He’s $150 a session (though this is again, this is an expensive therapist, you’re probably looking at $75-$100 a session, less if it’s in network or otherwise covered under insurance), which means I basically spend $300 a month to have someone who is a literal phone or text away in case of catastrophe and who keeps my head on straight the rest of the time. That is the cheapest, most worthwhile utility bill you’re ever going to pay in your entire life.
Four: There is nothing wrong with taking medication.
The first time I tried medication, I was eight years old, I tried two very strong medications, had a bad reaction, and wound up spending the weekend in the hospital because it made me hallucinate. While I was getting to the hospital, one of my hallucinations was in the car with me, and I tried to open the car door and run into oncoming city traffic to escape it. It did not work because child safety locks are a really great invention. With that in mind, please believe me when I say that I extremely intimately understand that the idea of putting a chemical in your body that changes your brain is a terrifying prospect and that side effects are not fun at all. Also, as someone whose grandfather was militantly against prescriptions and would verbally harass me as a child to stop poisoning myself because vitamins were all I needed, to the point where I had to engage in subterfuge with my mother to take pills while visiting him, I also understand there’s a sizable stigma attached. I hear you. These are all really shitty things that come with psychiatric medication. There are more I didn’t even get into, like the attached paperwork and verification hoops you have to jump through.
But, as great as therapy is (and believe me, it’s super great), it’s not a cure. It’s problem-solving. If your problem is something complicated like your brain chemicals not working properly, therapy is a great way to help you cope with the product of those brain chemicals malfunctioning, but it’s not going to fix the actual chemicals. A million bazillion studies have shown that people with any major psychiatric disorder have the best quality of life when they use both behaviorally based therapy (ie: therapy that is goal-oriented and focused on problem solving and coping strategies) and a regime of medication.
The way you get medication is to go to a medicating psychiatrist (the difference between a psychologist/therapist/social worker and a psychiatrist is that a psychiatrist can prescribe medication and the other people can’t). DO NOT go to them first, or only go to them. You still need therapy and you should always start with therapy. But all therapists have some familiarity with medications pertaining to their field of expertise and will be able to tell you pretty quickly if you need medication, what you need, and give you a list of people who might be able to give it to you.
You don’t have to be best friends with your medicating psychiatrist, since they are not your therapist. They’re a doctor. What you need from a medicating psychiatrist is someone who is diligent (so when you call in needing a prescription refill they do so promptly and with minimal fuss or complication) and willing to coordinate with your therapist. You don’t have to tell them every intimate detail of your life story, but you do need to feel comfortable telling them the pertinent ones, and feel as though you have the same philosophies regarding medication level (ie: how much and what types of medications you do or don’t want to use, and how much), they listen to your concerns, and are willing to change medication regime if the one they have you on isn’t working. Some psychiatrists, like some doctors, get really wedded to one thing that “should” work and don’t listen to you when you tell them it doesn’t. There are stinkers in every profession.
Once you choose a psychiatrist, have them schedule a phone conference with your therapist (again, you may have to sign some level of release, for confidentiality reasons, and depending on if they and your therapist are in the same networks or not) that you are not a part of. This is just so your therapist can give them the run-down of who they’re sending and what the therapist is thinking you need. Then, the psychiatrist meets with you, and you tell them your version. The psychiatrist then writes you a prescription, and you check in with them when they ask you to, usually every 8-12 weeks, and if you are altering medication they will possibly ask you in more frequently to check in, or at least ask you to call in and confirm you’re doing fine.
Again, like with therapy, it’s important you FOLLOW THE PSYCHIATRIST’S ORDERS or, best case scenario, the medication isn’t going to work, and worst case scenario, you too could wind up in the hospital. Do not change a single thing without a doctor telling you to. If you’re having adverse reactions, call into your psychiatrist immediately. Depending on how fast-acting the drug is, you might not feel a thing for two weeks, or you might start feeling it in under an hour. I highly suggest keeping a small journal and writing down anything out of the ordinary that happens when either going on or off new medication. Your psychiatrist will need to know and you will probably forget.
If people give you shit about taking medication, honestly, tell them to go fuck themselves. I know that’s a lot easier said than done, but fuck ’em. If they sprained their ankle they would take medicine. If they were diabetic they’d take insulin. If your brain isn’t working, you need to take medicine for that too.
Five: You will always be sick, but you will not always feel your worst forever.
Having a mental health issue is like having a buggy computer system living in your brain. The reason there are so many people with mental health issues is that the human brain is so complicated there are almost infinite ways to have a bug somewhere in there. Even though I have not had an anxiety attack in about two months (knock on wood) and a major anxious meltdown in at least a year if not more (knock even harder on wood), I will always have anxiety (and depression and ADD), it’s just how my system is rigged. It’s not going away.
Like with any buggy system, being buggy isn’t a static thing. Some parts of your life, you will rely more on this system and it will suck. Sometimes your system will have flare-ups. But there will also be parts of your life where you can bypass the system, or you will be able to work with the system, or even find new uses for it.
I have tried many Google searches trying to find why mental health comes and goes and sometimes you do really great and sometimes you do really badly, and honestly, I can’t find one. This is probably because mental health is an umbrella that covers so many complicated brain functions and is influenced by so many outside your brain things that scientists just haven’t been able to isolate why it is people don’t stay in mental ditches forever, regardless of what’s bothering them. The thing every expert can agree on, though, is that you don’t. Mental health is just one long, weird, unpredictable wave. You will get better. You might get worse again. You will be on this weird wave for a long time, getting better and worse, and we might never know why. There are some things that are too complicated to answer easily.
Six: No one can “fix” you but you.
I have said many times before and I will say as many times as I need to that I would not be nearly as healthy as I am today without the help of a lot of really great professionals and, most importantly, without my parents. My parents were endlessly patient with me continue to be endlessly patient with me (and my siblings, both of whom have anxiety disorders) to this day. They supported me through seven years of being housebound, they counselled me and held me through all my panic attacks and depressions from the time I was a very young kid, they drove me to and paid for all the counselling and testing and doctor’s appointments I needed to go through. They were accommodating, but they always pushed me to do better and believed in my ability to heal myself, even when I did not share their faith. Were I designing parents for someone with a mental illness to have, I could not have done a much better job. And were I designing siblings or friends to be supportive, I could not have designed those better than the ones I have, either.
But with all that being said, my family is not what made me better. My therapists are not what made me better, nor are any of my friends, nor is any of the medication I took. All the arbitrary things I have cited as being helpful multiple times – hockey, having pets, keeping myself active in terms of creativity – none of these things made me better. They were all just tools. They didn’t do it.
I did it.
I am not special. I messed up making myself better a lot, and repeatedly. It was really, really, really hard work. But I could have – and for a long time, I did – have all the tools in the world and no desire to use them.
Here’s another, simpler metaphor: getting better is like making an omelette. There’s no rule as to what goes into the omelette. It can be a whole bunch of things, and there are certain things that people know work really well in producing a tasty end product. But the only thing that you actually need to make an omelette is the eggs. The eggs, in this case, are you wanting to get better and being willing to put in the hard work, even when you have no idea if it’s paying off. Without that, you have a bunch of useless chopped up food and not a lot of protein.
Nothing makes me frustrated faster than someone saying something “saved” them. It’s impossible to pin that burden on someone or something, and what’s more, it’s dangerous to both you and them. Being someone’s savior is a huge, heavy burden to bear. You are the only person strong enough to save yourself. You are the only person who ever will.
Seven: Progress is slow and messy, perfection is impossible, and staying better is hard work you will sometimes fail at. Celebrate small, seemingly meaningless victories and take as long a view as possible.
I cannot pinpoint the moment that lead me to stay in my house for seven years. I can pinpoint what triggered it – my friends all left in the fall of 2007 for college and I did not – but the reason I did not was because I’d been on a downward trajectory for a really, really long time, and agoraphobia was just the cumulative response to that that. Similarly, I cannot pinpoint the moment I started leaving the house again without fear. (Or, more accurately, started leaving the house in spite of being terrified and did so often enough that my body taught itself to stop being terrified.)
When I turned 26, my parents gave me a card and my mom wrote in it “25 was a great year, I bet 26 will be even better!” And this is going to sound weird, but even though I was, at that point, finally long-term employed and doing well at my job and not panicking regularly for the first time in a long time and reconstructing my social life and had actually started exercising (something I passionately resisted for my entire life), it had never occurred to me that I had actually gotten better. In part it was because I was so used to thinking of myself as a hopeless failure that I’d just never made the switch, but mostly because it just happened so slowly I didn’t notice. Did it happen on the day I first got my job that I would go on to be at for 21 months? No, because I had jobs I’d had to quit because of my anxiety before, and none of them had made me better, so I had to have been better before I got my job. But when I got my job, I still had panic attacks every time I got on public transportation and wasn’t exercising and had no friends outside of my computer or living in the Boston area, so what was it? When was I better? What was “better”? I keep meticulous logs of my life on social media and have been since I was 14, and I have combed through them, looking for answers, moments where I can point to and say “this made me better” or “this made me worse”. It’s impossible. It’s too complicated to boil down that easily.
I’m guess I’m still in the process of getting better, though honestly, I don’t know what “better” looks like. I know that I have a routine that keeps me able to at the very least mimic adulthood, and a life that in some ways works and in some ways doesn’t, and I am working on improving the parts that don’t. I know what is hard, what is easy, and how to take care of myself. And honestly, not to get too Philosophy 101, but what is “better”, anyway? Everyone has shit about themselves they’re working on improving, and at certain points you’re accomplishing that, and at certain points you’re not.
Mental health – and life, for that matter – is a marathon. If you’re reading this, you’re running it. If you’re getting a Charlie horse in your brain, there are people to help you with that. Don’t analyze the miles you’ve run before, and don’t over-plan the miles you’re going to run after this. Your only job is to keep moving, even if you’re barely dragging yourself along.
You got this.