The au­thor, a Har­vard-trained pae­di­a­tri­cian, has en­dured four men­tal break­downs. Each one taught him to think more clearly>

Men's Health (Australia) - - State Of Mind - BY DR MARK VONNEGUT PHO­TO­GRAPHS BY BENE­DICT EVANS

couldn’t sleep or eat for sev­eral days. Then I started hear­ing voices. Not gauzy, spe­cial-ef­fects voices, but ac­tual, real voices com­ing from out­side my head. It’s the kind of thing that can’t be ig­nored. When some­body says hello, it’s im­po­lite not to say it back. Hi. Hello. Hello? So you end up in a con­ver­sa­tion with your­self, but it doesn’t feel that way. It feels like you’re talk­ing to some­body else. Some­body out­side your­self.

In the be­gin­ning the voices were fairly friendly, but then they be­came more in­sis­tent and crit­i­cal. Un­for­tu­nately, they have a lot of in­side in­for­ma­tion that can and will be used against you. You don’t know you’re men­tally ill, so you sim­ply as­sume that things have changed for ev­ery­one. Maybe hear­ing dis­em­bod­ied voices is just part of the new deal. I re­mem­ber sit­ting down next to a friend and say­ing, “So what are your voices telling you?” He got up and found him­self a dif­fer­ent place to sit. This was 45 years ago.

Ul­ti­mately my friends couldn’t put up with me be­cause I did things like break a big pic­ture win­dow. (I thought we were suf­fo­cat­ing.)

Ev­ery­thing I did made sense to me and much of it was heroic. My friends got hold of my fam­ily who did the sen­si­ble thing to do with some­one who’s floridly psy­chotic: they put me in a psy­chi­atric hos­pi­tal. The hos­pi­tal gave me large doses of an­tipsy­chotic med­i­ca­tion and put me in seclu­sion.

Bipo­lar dis­or­der and many other men­tal ill­nesses are heav­ily in­flu­enced by ge­net­ics. It helped that my mother had had sim­i­lar symp­toms. When I com­plained about the voices, she was able from her own ex­pe­ri­ence to say, “Why don’t you just go along with them?”

When I told her I thought I could fore­see the fu­ture, she said, “Well, who doesn’t?”

I wasn’t unique. She nor­malised the symp­toms and showed me that hav­ing psy­chi­atric is­sues wasn’t the end of the world and that I wasn’t alone.

My mother came to live with me af­ter my first se­ries of breaks. Among the many things wrong with the the­o­ries that blame par­ents for men­tal ill­ness is this one: who else is go­ing to put up with you/me/us?

Re­cov­er­ing from men­tal ill­ness is not a del­i­cate, touchyfeely busi­ness. Here are four things to keep in mind:

Talk­ing with a ther­a­pist or psy­chi­a­trist might or might not be use­ful. It’s worth a try.

Med­i­ca­tion might or might not help. It’s worth a try.

Ig­nor­ing the symp­toms of men­tal ill­ness won’t help you or those around you.

Eat­ing well and get­ting more ex­er­cise is never a mis­take. Hav­ing men­tal ill­ness gives you a bet­ter rea­son than most to eat well, run, lift weights and go to the box­ing gym.

HALF OF US will have some sort of men­tal health prob­lem in our life­time, but only a small pro­por­tion of us will seek pro­fes­sional help. Un­like red wine and stinky cheese, se­ri­ous prob­lems like anx­i­ety, de­pres­sion and psy­chosis tend not to im­prove with age and ne­glect. If you wake up one day and think you might need help, then you need help.

Hear­ing voices and hav­ing delu­sions and para­noia, the hall­marks of con­ven­tional lu­nacy, are thought dis­or­ders. Mood dis­or­ders – feel­ing ob­nox­iously happy or par­a­lyt­i­cally sad, or noth­ing at all – can be just as dev­as­tat­ing. Bonus: the two can go to­gether.

Men­tal ill­ness is not about hav­ing quirky thoughts or be­ing a lit­tle up or down. Men­tal ill­ness makes it hard to take care of your­self. Hal­lu­ci­na­tions, delu­sions, bizarre be­hav­iour – es­pe­cially the vi­o­lent kind – get the most at­ten­tion, but the real deal is of­ten more static. It’s be­ing un­able to get out of bed, go to work, be part of a fam­ily. More peo­ple are af­fected by men­tal ill­ness than by di­a­betes and heart dis­ease com­bined. Add the bur­den it im­poses on loved ones and ev­ery­one feels the pain.

But the lone­li­ness is tough­est. When I had my sec­ond episode I was again iso­lated. I’d tossed my medicine be­cause it made me slug­gish. I didn’t think I had an ill­ness any­way. It was just a weird thing that had hap­pened to me, I fig­ured. So when the symp­toms re­turned, the only med­i­ca­tion avail­able was mar­i­juana – not the best choice. It made things worse. The next pre­scrip­tion avail­able to me, as a fool­ish per­son, was from Jack Daniel.

De­pend­ing on your point of view, turn­ing to drugs, al­co­hol and other sub­stances may not be morally bad choices. But these are not op­ti­mal treat­ments for anx­i­ety and de­pres­sion. The prob­lem is that al­co­hol works well in the short run. If you’re anx­ious or de­pressed, al­co­hol makes the pain go away. It can also tone down the voices and ag­i­ta­tion, but it leaves the door open for them to re­turn stronger. Drugs and al­co­hol abuse waste your time, de­stroy re­la­tion­ships and make you sicker. Ad­dic­tive be­hav­iours may make it eas­ier to get through an af­ter­noon, but they won’t make it eas­ier to get through life.

Stay­ing healthy – lift­ing those weights, walk­ing those kilo­me­tres – will. Know­ing that about your­self can truly save your life, not to men­tion many dol­lars. Tak­ing your­self and life se­ri­ously makes you a much more au­then­tic and em­pa­thetic friend – which, if you ask me, is more im­por­tant than achiev­ing any state of so-called nor­malcy. If a medicine or a ther­apy isn’t mak­ing you more ac­ces­si­ble to gen­uine friend­ship, then it’s a waste of time.

break 45 years ago I’ve had four more. For al­most a half cen­tury I’ve had a life crowded with psy­chi­a­trists and up­hol­stered by psy­chi­atric med­i­ca­tions.>

But one way I’ve given my life mean­ing has been by de­mys­ti­fy­ing my men­tal ill­ness and help­ing other peo­ple be less afraid of theirs. These ill­nesses are ter­ri­fy­ing, but fear doesn’t help. Be­ing alone and try­ing to go one-on-one against them is even worse. I’m grate­ful for the care I’ve re­ceived. I want to give back to those who made it pos­si­ble and help oth­ers un­der­stand what works and what doesn’t.

What works bet­ter now than 45 years ago? We know more about men­tal ill­ness. We have bet­ter drugs. Men­tal ill­ness is about neu­ro­chem­istry and not some­thing we should blame on the in­di­vid­ual. Shame, blame and guilt of­ten cause as much suf­fer­ing as the men­tal dis­eases that trig­ger these things.

If you are suf­fer­ing, you can im­prove with­out per­fect pro­fes­sional care. The things you can do to take care of your­self are pre­dictable: eat well, sleep well, ex­er­cise, don’t drink, don’t iso­late your­self and don’t take a drug un­less it’s pre­scribed by a doc­tor. Men­tal ill­nesses are dis­eases of lone­li­ness. Proper med­i­ca­tion makes healthy re­la­tion­ships pos­si­ble.

But the best way to get out of your­self is to be use­ful to oth­ers. Con­tribut­ing – to friends, a lo­cal li­brary, a com­mu­nity, the world in gen­eral – is a great way to get back your health and bal­ance.

Like ev­ery­one else, I had an im­per­fect child­hood and en­gaged in oc­ca­sional un­wise teenage be­hav­iours, but un­til my first cri­sis, I was hold­ing it to­gether. I grad­u­ated from univer­sity. I had friends and girl­friends. I had lofty goals, as­pi­ra­tions, en­ergy and a mostly pos­i­tive mood. Af­ter work­ing for a while I started a com­mune in Bri­tish Columbia – which was not a sign of men­tal ill­ness, by the way.

We did not sit around smok­ing dope and say­ing “Wow”. We worked hard to­wards our goal of be­ing a self-suf­fi­cient refuge. We built a house, had enough food, lived healthy lives. But then, partly in re­sponse to things that shouldn’t have been enough to make me crazy, I stopped be­ing able to eat or sleep. I felt over­whelmed by em­pa­thy for all liv­ing things, even trees. I started hear­ing voices, imagining that the world was com­ing to an end and that I was sup­posed to do some­thing about it.

Much as I would like to say that love, kind­ness and wis­dom saved me, what helped me acutely – and helps most peo­ple – were hos­pi­tal­i­sa­tion and med­i­ca­tion, which even­tu­ally made it pos­si­ble for me to have healthy re­la­tion­ships again.

I had been raised to be­lieve that there was no such thing as men­tal ill­ness, that psy­chotic think­ing was a rea­son­able reaction to an un­rea­son­able so­ci­ety. This the­ory doesn’t help you get well. I hated be­ing sick and fought to get bet­ter. As my mind cleared, I did things that made me bet­ter. My abil­ity to do maths and sci­ence came back. I re­turned to school, took pre-med classes and ap­plied to 20 med­i­cal schools. The only one that ac­cepted me was Har­vard. As a friend said, “Well, at least you got into one.”

I grad­u­ated from med­i­cal school and have prac­tised pae­di­atrics for over 35 years. I have a wife, three sons, five grand­chil­dren and two dogs. I coach soc­cer and have writ­ten a few well-re­ceived books.

The fact that I don’t be­have and look like some­one who needs med­i­ca­tion means I’m tak­ing about the right dose. It helps that I have a pro­fes­sional and per­sonal life I don’t want to lose. Psy­chi­atric drugs have se­ri­ous side ef­fects and you’d be crazy to take them if you didn’t need them. How­ever, they can be very ef­fec­tive and you’d be even cra­zier not to take them if you did need them. I had a fourth break 14 years af­ter the first three. Get­ting bet­ter was harder that time be­cause I was older. But I knew re­cov­ery was pos­si­ble and roughly how it would go.

A BRIEF LIST OF treat­ments I have tried over the years:

Me­gavi­ta­mins: they might work, as a placebo.

Elec­tro­con­vul­sive ther­apy (ECT): it’s a last-line ther­apy for pa­tients who are not re­spond­ing to other ther­a­pies or are at risk for sui­cide.

Mood-sta­bil­is­ing meds: this is a pri­mary treat­ment for peo­ple with bipo­lar dis­ease.

An­tipsy­chotic drugs: they help ease symp­toms such as hal­lu­ci­na­tions but can have some se­ri­ous side ef­fects.

Strait­jack­ets and iso­la­tion: they’re a way to con­trol pa­tients, not treat their ill­ness.

Talk ther­apy: it’s use­ful once you’re no longer psy­chotic.

Ex­er­cise: it’s life­sav­ing. Find ac­tiv­i­ties you like so you’ll ac­tu­ally do them.

THE PROB­LEM WITH most men­tal pa­tients is that the ill­ness in their head makes them not trust their feel­ings.

When med­i­ca­tions work, they make it pos­si­ble to be with oth­ers. The arts can be help­ful (some of my favourite pos­ses­sions are paint­ings I made in men­tal hos­pi­tals.) Read­ing good nov­els can be too.

Stigma is still alive and well, adding to the pain of men­tal ill­ness. Fear of be­ing found out and judged makes for lone­li­ness, and fear of ask­ing for help makes it hard to get help. Talk to friends and fam­ily you trust. While we’re far from per­fect, we know more about men­tal ill­ness and are less fear­ful of it than we used to be. It’s not al­ways easy to ac­cess good care but many of us get by with help from friends, fam­ily mem­bers and other pa­tients.

‘‘These ill­nesses are ter­ri­fy­ing, but fear doesn’t help. Be­ing alone against them is worse”

Life is a se­ries of swings and round­abouts.

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