Damn. {spoiler} SI

You know those days? I mean the ones that get away from you. You have plans, you have obligations, maybe you are supposed to meet someone for dinner, maybe you just have work to do, or a blog thingy to write. Best laid plans, eh?

So, a couple of days ago I was sitting on the couch. It was early, since I don’t really sleep much past 5, and my husband had already left for the early shift. (Why does this stuff always happen in the semi-dark?) I was fine. Fine. Fine. And then suddenly, I wasn’t.

To be fair, it has been a rough few weeks. I barely have any work, and my husband was off work for a bit with a dislocated shoulder. There was one week where we had $7, and half a carton of milk. That was a little dicey. There were acres of time, and nothing to fill them with, sitting next to an empty fridge and half a bag of cat food.

But back to the couch.

Suddenly, without any real warning, all of the little lies that mental illness tells you wormed their way out of whatever corner of my brain they hide in when I’m well. Sort of like herpes simplex B viruses that lurk until you get a sunburn, and then wham, cold sore, but with more consequences. The speed at which I went from placid, dull stream, to angry, anxious tidal wave, was a little overwhelming.

I tried all of my coping stuff – sort of. The breathing, the talking to myself, but all of that is hard when you are shaking and crying and you pretty much feel like you deserve to be that miserable so why try to fight it?

The rest of the day was a write-off.

Being the good little mental patient I am, I took the benzo I’m supposed to take when I can’t calm myself down. The idea is the benzo will help the situation from escalating to the point where I have a panic attack or crash in a really bad way. This usually works, but there was a bit of a problem. My fascination with sharp objects was sort of back. I couldn’t stop thinking about them. Bits of glass. Sigh.

I was really good when I moved. I threw out all my stuff. All the little chips of glass , the broken bits of plastic and all the rest of the sharp things. I was proud of myself. Unfortunately, I was really unhappy about that now.

Ultimately I found something, and I did a bit of damage. Nothing major. No wound management. Just a smear of polysporin, and a whole lot of explaining when my husband got home. The trouble is, the damn thing works. The anxiety basically vanished. What the hell. How did I end up here again? No wearing a bathing suit in front of my normal friends for a few weeks for me.

So here’s what happened.

The benzo is dis-inhibiting. It can be sort of like being drunk. Sometimes I just sleep, but when my thoughts are really swirling around sharp things, it can get dangerous. The last thing I need when I am fighting something like self-injury is a hit to my decision-making abilities, and I had kind of forgotten that.

The benzos work really well for anxiety, I don’t want to totally knock them, but when you are working with dodgy safety issues, lowering you inhibitions is not really something you want to be messing around with.

So I fell off the wagon, and I’m not really happy about it. I’m trying to figure out if this is a giant red flag, flying on a pole over my couch, or if it was just a really bad day, and some iffy decision-making. I’m not really sure yet. On the one hand, I’ve blown 2 years of good behaviour, but on the other, that two years came from not beating myself up over slip ups, and not spending a lot of time promising myself I would never do it again. Taking that pressure off has been really good for me, but I could feel the shame/berating myself thing creeping back later in the day.

I think I’m ok. I’ve poked and prodded my brain over the last few days, and nothing is leaking out. I’ve had some horrific dysmenorrhea the last couple of months, and that always feels like bone-crushing depression, but all the other signs are good. I think I just have to chalk this up to a bit of not paying attention, and a higher level of anxiety than I’ve had in a while.

I’m in one of those phases where everyone is telling me how fabulously I’m doing, and how all the troubles are behind me, but you know what? They never are. I can have months, or years of really good, stable times, but if I let my concentration go, if I stop paying really close attention, it gets away from me. You can question whether mental illness is a biological entity, or a social construct, or some cool, unique feature of my personality that makes me creative and special, but when it comes down to it, it doesn’t matter.

In the semi-dark, when it’s just me and the cats and my thoughts, it still behaves like a chronic illness. I still have to deal with it every day. It doesn’t go away, and when I pretend that it has, it sneaks up on me. The lying, cheating beast that is mine slinks up to my ear and whispers the litany of all the horrible things I’ve ever done, and all the people I’ve ever hurt, and all the things that will always be wrong. Even though some part of me knows it isn’t really true, and that I’m not evil incarnate, I buy it.

So I need to be more careful. I need to get more sleep, and I need to deal with the stress in my life. The risk of thinking that everything is ok is not really one I should be taking. Recovery doesn’t mean you can leave mental illness behind you. It just means you figure out how to continue living with that particular piece of luggage on your rack.

Oh, and I didn’t make it to dinner. Sorry.

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I’m not sure if it’s time to post to Facebook again

It is Mental Health Awareness Month again around here. Last year I wrote an epic status update on Facebook, outlining my mental health issues, well, some of them. It was a fairly effective way of outing myself to more distant family, those weird Facebook-only high-school friends, and the odd collection of people I have gathered from various random sources (mostly friends of friends). This last group are mostly Americans, who argue endlessly about politics and gun control, so the whole revealing myself as a crazy person was a bit of an interesting experiment.

For the most part everyone behaved. There were the usual “don’t call yourself crazy” lectures, and a lot of “but you aren’t like ‘those’ people”, and of course the obligatory “but you seem so normal”. All sort of annoying and condescending in their own special ways, but well meaning, and pretty much willing to listen. The thing I get the most reaction to is the whole “I wouldn’t change my experiences if I could” thing. Most people just can’t conceive of not needing to be cured of bipolar disorder. To them mental illness has no up side, no positive angle. What they are not seeing is the fact that I would not be who I am without it. Being bipolar is pretty fundamental to the way I developed. It gave me my self-reflection, my compassion for suffering, my understanding of power dynamics and oppression. It gave me a much more robust understanding of joy, contentment and happiness than my peers. I see the light better because the shadow defines it.

So, now that it is “be condescending to a crazy person” week again, I have to decide if I am going to post this year. It has been a much better year, as I measure them. I got healthier, I didn’t get hospitalized, I left some groups that were draining energy from me, and I spent more time with friends who really support me. I’m ready to work (even if I don’t have much of a job yet), and my mood is pretty stable.

Ok, not totally stable. I completely had a panic attack a few days ago, but it is a good story. In the past a panic attack would have collapsed me for days. The recovery was always slow. I became one with the couch. This time I made cookies. Literally. I went home and baked. My husband fully supports this coping mechanism. Apparently, I am learning how to manage again. I suspect that perfectly ordinary, mentally stable people bake as a coping mechanism too. There are way too many baking magazines in subway news shops for this to be just about providing sweet sustenance to your friends and family. I think I have stumbled on to a great secret of the sane world – baking as an antidepressant! Don’t tell anyone. Big Pharma will have it packaged in less time than it takes to brown the edges of a nice peanut butter oatmeal cookie. It can be our little secret. Oh right. Facebook.

I object to Facebook on a number of levels. I am not the user, I am the product. Facebook owns everything I post. They own all my little political rants, and my reposted pictures of kittens, and all the weird conversations I have with old roommates. They own my last “I’m crazy” post. They own all the responses from my nearest and dearest and others. I know that, and I rationalize it by saying that I post with eyes wide open. I know I am giving my words up, so somehow it is ok. It’s not really, but most of the people I “know” on Facebook have no other contact with me, and so I have no other way of contacting them. Ah, the life of the netizen.

The other thing, says my HR manager best friend, is that I am wrecking my employment reputation by ranting about city council and the federal government. I maintain that any employer who would disqualify me based on my dislike for our mayor, is not an employer I would want to work for, but as my savings and my family’s good will dwindle, this feeling is eroding. So, if my potential bosses would freak out because I have a serious problem with his worship, or our glorious leader, it stands to reason that they would shred my resume seconds after reading about my mental health. Stigma-busting and supporting workplace mental health are great for corporate fundraisers, but god forbid you actually have to hire one of these people.

So I’m torn, between my own little Facebook activism, where I force my friends to recognize that they interact with a nutcase on a fairly regular basis, without appreciable trauma, and wanting to present a clean, or sanitized view of me to the working world. I want to be sort of in your face about my illness. I’ve always said that I had enough backup that I could afford to be really open about my life. That resolve is being tested. It pisses me off, though. I know that we all curate ourselves for different audiences. Who I am with my mother is awfully different from who I am here, the sticky part comes when you have to hide parts of yourself, or risk being ostracized or left out. In this case it would mean continued poverty and deprivation. I don’t like being told what to do, and not posting on Facebook feels like someone telling me who I can tell about me. I don’t like it.

Chances are I will post. Some part of me likes watching my acquaintances wriggle around in discomfort as they try to be supportive. Maybe like is the wrong word. It is more about some level of satisfaction that they have had to stretch their minds a little to encompass something they are really good at compartmentalizing away. It is ok for Annette to be eccentric, but keep the mumbling real crazy person away from me. They don’t understand how closely related to that person I am, but that isn’t really the point. Posting about my illness is practice for being out in the world. In my vain little head, I can change them. I can make them think differently. Maybe I can get them to treat someone better, or judge someone less. I’m foolish and pig-headed that way.

On Thumb-sucking, Security Blankets and Trusting Myself Again

It has been a year and a half since I was discharged from the hospital. I still struggle with keeping my feet under me, but for new reasons. I’m not depressed, I’m not battling crippling anxiety, and I have not had to fight off mixed episodes or general craziness for a while. It’s been pretty good, from that perspective.

The real problems are things I am less familiar with. I need a job. I need some direction. I need more sleep. I need to get the physical issues under control.

The medical stuff is sort of crazy related. The kidney damage from the meds means that I have to drink a lot of fluids. That seems to have antagonized my bladder, and now I can’t sleep for more than an hour or so without having to get up. I’m sort of getting used to the sleep deprivation, but it makes everything else that much harder. But, I’m getting off track. This is not meant to be a whine about my aging, cranky body.

I do really need a job. I’ve applied to a whole host of jobs I am sort of qualified for. I have a newly minted masters in Educational Technology, and a few years experience in creating online courses for clients, but my resume is horrible. It is just a listing of all the things I either failed at, or failed to finish. It is a mess of jobs, a career I bailed on, and a collections of degrees that make me pretty interesting in conversation, but not the kind of person you would hire. I’m going to need to luck into something, I think. I have a line on some freelance contracts, and you hate to put all your eggs in one basket, but there are not a lot of baskets around at the moment.

I guess I need to find some way to sell myself, never my strong point. Part of the problem is that I’m not sure how much I believe in the product.

Every time I get sick there is a long road back to being ok. Part of the process is giving up the security blanket. I know how to be a sick person. I’m a pro. The people around me, the ones who love me and support me, know how to deal with a sick me too. We have a lot of practice, dealing with the sick girl. I know how to ask for help, for pity, for support, I know how to get what I need when that constitutes coddling and walking around me on eggshells. That sounds really bad, and it isn’t actually that awful. When I’m sick, I need help with really basic things, like laundry and groceries. I need someone to help me get my bills paid, and to tell me to stop crying, and that I can do this. I really need cheerleaders to get me through when I have no faith. I need hand-holding, and reminders to eat and sleep. It is pretty hard on my husband, and my family, and I’m sure it does not endear me to my friends.

When I’ve been hospitalized, it usually comes as a huge relief to my husband. He can go to work without worrying that he will come home to my body. He knows I’ll be safe there, and he can relax a little, usually for the first time in months. Once I’m discharged the worry starts up again. There is always the questions of just how “better” I am. How long can I be left alone? Will I remember to eat, to sleep? Every bad day is a warning flag. Every bad mood is a potential disastrous slide down into a pit. Every night of bad sleep, or every ridiculously early morning, brings up questions of hypomania. If I am irritable, it is a bad sign. If I get angry, it could be the harbinger of doom. All the people in my life, including me, judge, evaluate, dissect, and categorized my moods, the things I say, and all the other indicators we can come up with. It is a pretty exhausting process, but for a while anyway, it sort of needs to happen.

When you come out of an episode, you are still really fragile. You are like the insect, newly moulted. The new skin, or the new exoskeleton, is soft, and offers very little protection. You need to keep wrapped up in the security blanket. You keep sucking your thumb, for comfort, and as a reminder that you are not yet whole.

Obviously, this can’t last. You need to give up on the protections and get out of your head and into the real world at some point, or the recovery stalls. The problem with this is trust. I have to trust myself. I have to start to believe that a bad day is just that – one day – and not the beginning of the end. This usually takes me a couple of months. It is slow, but I get there. The process is slowed down, though, by my well-meaning loved ones, my doctors and the world in general. They protect me, the keep pulling the blanket up to my chin, they dance around me like I was made of only slightly hardened jello. It is way too easy to buy into this.

This time I didn’t have a job to go back to. My job disappeared into the meltdown of the company I worked for. Every other time I have been working on getting my act back together I have had a job to go to. I’ve had responsibilities, and a place to show up at. This time it’s just me, and school, and school is done now. I have no external structure to rely on for a reality check, and so I have been relying on the people around me, and they don’t trust me.

Well, they trust me, they just don’t trust that I am healthy, or that I can handle adversity, or that I’m not teetering on the edge of disaster at all times. My problem is I tend to buy into this a little too easily. It makes me question myself, and, let’s be honest, it is too easy to give in to it. It enables me to stay sick, or stay fragile, longer than is really necessary. I get to figuratively limp around for a lot longer than I really deserve.

This time is has been worse. I was really sick for a lot longer than usual. I was hospitalized twice in one year, which has never happened before, and I scared the bejeezus out of the people around me. Hell, I scared me. Getting better was hindered by the fact that I wasn’t really sleeping well. I’m still not, not really. Plus, there was the problem of not really having anything to do. I was in no shape to job hunt, and I could barely put sentences together for school. It was a very long, slow process. I had a lot of little relapses, very bad weeks, and some rather dumb slip-ups. It has taken a year to get to the point where I could realistically do a full-time job. So now, I have to get rid of the security blanket.

I’m terrified. I’ve been protected and coddled for two years, and now I’m facing the prospect of just being fine, of giving up my special status, of being ok. I don’t think that I can adequately explain what it is like to give up on the fantasy that you are sick and fragile, or impaired. You lose your excuse for everything. You have to take full responsibility for everything. I know how spoiled that sounds, really I do. It is just that when I am sick, I really can’t do all this stuff. I really am disabled, impaired, or broken. There is just an invisible line that you cross, where one day you are weak and in danger, and the next you are doing ok, a contributing member of the world.

I’m at that point.

Wish me luck, but not too much. I need to get my act together on my own.

On side effects and choice

So, I went to the doctor today, because they wanted to talk to me about some blood test results. No problem I thought. My creatinine reading is usually off, and I figured that’s what they were worried about. It’s a walk-in clinic doctor and I had forgotten to warn them when they ordered the blood work. I have Nephrogenic Diabetes Insipidus from taking Lithium for 12 years. It means that my kidneys don’t concentrate urine. Long story short, I know where all the public washrooms in the Greater Toronto Area are. Not fun, but I have learned to live with it.

So I’m all prepared with my speech about how I forgot to warn them about the blood test. Problem is, that wasn’t what was wrong. Turns out the filtration rate in my kidneys is so low it is indicative of chronic, severe kidney disease. Off to the specialist with me. When I originally had problems, the specialist said I might lose 2-10% of my kidney function per year, or nothing might happen. I had been going with the nothing option because I had no symptoms and everything else seemed stable. Looks like I might have been wrong. Specialists are on holidays in August, all of them apparently, an no one seems alarmed enough to send me to a hospital, so I get to wait until September to find out whether panic is appropriate in this situation. Either way, it is making me think.

On a mailing list I am a part of, there has been a discussion lately about ECT. Specifically the ethics of putting an ad online looking for volunteers for a study, with the explanation that ECT “creates new brain cells”. This last bit was news to me, as far as I know creating new brain cells, not just new connections, is up there with having tea with a Higgs-Boson particle in terms of probability. Either way, this ad created a great deal of discussion. There was a response to the ad in this online forum, in which the respondent called ECT a human rights abuse. I am not a fan of throwing terms like that around, it smacks of fear mongering and invalidates the experiences of people who have benefited from ECT.

I have two friends who have been zapped in a medical way. Both of them experienced some memory loss, but they also derived benefit from the procedure that lasted for quite a long time. They have both had ECT multiple times and neither of them seem bitter, angry or feel they were coerced into consenting. This is not to say that all people who have ECT have a lovely time of it. Many people are seriously damaged, there can be catastrophic memory loss, and some people lose themselves entirely. ECT is obviously a last-case scenario as far as I am concerned.

One of the big issues was consent, specifically informed consent. Many patients are given a pamphlet, and a date and time for their first treatment, and that’s it. This is obviously not sufficient. One of my issues with consent while you are an inpatient is a bit tricky for me. I know, from my own experience, that when one is suicidally depressed you don’t always make the best decisions. For example, some depressed people are in so much pain that they decide to kill themselves. Probably not the most rational decision. When you are that depressed, and therefore a candidate for ECT, is it even possible for a person to give consent or are you so tortured and in so much agony that you would consent to a lobotomy if you were told it would alleviate your suffering?

There is a great deal of discussion on the list, and among patients in general, about autonomy and choice and being in control of your own treatment. There is a lot of talk about how we are sometimes treated against our will, that doctor’s prescribing practices are heavily influenced by pharmaceutical company PR and swag, and that the mentally ill are treated like imbeciles. We are “in denial” or “not in our right minds” according to the advertising campaign of one of the big hospitals here, and this touched off a firestorm of offence and indignation in the part of the community I am in contact with. The argument being that madness is not incompatible with competency, that we are still able to be part of our treatment decisions and that we are not mindless idiots because we occasionally lose our marbles. To a certain point I tend to agree with this.

The problem lies in the fact that you can’t have it both ways. Either you are competent to make decisions, and can consent to ECT, or you are not. If you are not, all choice is taken away from you and you lose all control. If you consent to something like ECT out of desperation without really understanding the consequences because you are too out of it, you could end up losing years of your life. It is a difficult thing to grapple with.

Historically the mentally ill have been treated very badly. There are still people alive today who were treated with lobotomies and insulin comas. Very often a crazy person would be locked away from society until their minds had been destroyed by drastic treatments. The goal was often not to cure, but to make the person docile enough to manage. There was not a lot of informed consent going on.  In the age of pharmaceutical miracles, drugs were used that caused horrific side effects. They controlled the psychosis or the mania, but left the patient little more than a zombie, or caused irreversible movement disorders. Patients who rebelled and decided to live with the psychosis rather than become a chemically created member of the living dead were often involuntarily committed for non-compliance. Neither option is really ideal.

In my time as a medicated crazy, the drugs have been marginally better. Sort of. Some of the newer atypical anti-psychotics are known to cause diabetes or metabolic disorder, weight gain is a given, tardive dykinisia is still a very real possibility and even the much lauded anti-depressants have serious side effects. I have often been told that the side effects from the SSRIs are negligible, and are no reason to stop taking them. Some of them include: decreased sexual ability, somnolence, agitation, increased risk of suicide, significant weight gain, and many more. None of these will make you very happy, and some of them are serious health risks. Benzodiazepines, which are the miracle drug of choice for anxiety, are fabulously addictive. They are the famous “Mother’s little helper” that so many people have become addicted to. They are also ridiculously cheap, and handed out like candy. One of the side effects of heavy benzo use is depression, which can lead to a prescription for SSRIs. You can see where this might lead.

As I mentioned before, I have had serious problems with lithium. I never had a problem with feeling dulled, or stupefied with lithium. I was always able to function well, and maintained my ability to be creative, but the long-term effects on my body have been harsh. I don’t actually regret taking the drug. When I am being honest with myself I know I would not have survived the 12 years I was on it without the stabilizing effect of the medication. I just wish there had been more alternatives.

I also took another medication in the 90’s which unbeknownst to me rendered the birth control pill ineffective. This was not listed as an issue in the product monograph, and my doctor was not aware of it until I showed her what I had found on the internet. From what I understand, that is part of the product warning now, but when it affected me there was no mention of it. Not a great way to engender trust in your customers.

There is a lot of research into medication now, and a huge emphasis on medical treatments for mental illness. I believe there is something wrong with my brain, and I am not opposed to medication, but I find this single-minded focus on drugs to be alarming. There are a number of non-chemical treatments for mental illness that have been found to be very effective. Cognitive Behaviour Therapy and Dialectical Behaviour Therapy being the two examples I am most familiar with. There is also some evidence that improving the living situation of the person tends to improve the symptoms of the illness.

Being in a panic about whether you will have a safe place to live and enough food to eat will exacerbate symptoms of even mild depression and anxiety. The stress of living in poverty, or fearing for your safety, can be triggers for mental illness, and there is a lot of research that mental illness is much more prevalent among the poor.

I worry that the focus that is placed on the biological determinants of the illness takes away from attention being paid to the psycho-social factors that are involved. There is a lot of money for new drugs, but the waiting list for the DBT program at the local psychiatric institution is two years long, and they only open it up for new people every once in a while, so you have to keep calling and hope the list is open that day.

Doctors who are being honest will tell you, and I have been told this, psychopharmacology is still in the medieval period of it’s development. We still don’t know why the medications that do work, work. The mechanisms of how drugs relive the symptoms of mental illness are hinted at, and researchers have some ideas, but they have not been completely pinned down yet. In the mean time the pharmaceutical industry is driven, not by altruism, but by profit. GlaxoSmithKline was recently fined $3 billion dollars for misconduct in the promotion of it’s products, two of which are used in the treatment of depression. This does not make me trust them more.

I fully believe that medications will become better and safer, and I think that eventually pharmaceutical companies will be reigned in and will not be able to exert as much pressure on doctors. I think there will be more regulations about publishing all the studies which are done on new drugs, not just the ones that support the position of the drug companies that funded them. I also think mental health treatment will become more humane, and more compassionate. I think there will be more funding for non-medical interventions and community support. I am glad that I went mad now and not 60 years ago.

I do wish, though, that there was more weight given to the issue of side effects, and damage to patient health. Side effects can be debilitating, physically and mentally. Most people who are not compliant with medication regimes are that way because they cannot tolerate the way the drugs make them feel. This is very rarely taken into consideration. I had a doctor ask me once, during a lecture I gave, what to do about a non-compliant patient. She said “I keep telling him how good the medication is, but he just won’t take it”. I asked her if she had asked him why he wasn’t taking the medication, and she just looked at me blankly.

Medicine, regardless of the whole “do no harm” thing, is not without risks. Surgery is risky, chemotherapy is poison and causes infertility and infection, there are no medications without side effects. Psychiatry is no different. Until more research is done and safer drugs are available we will have to live with either serious illness or serious side effects. Psychiatry needs to make sure that there is informed consent, which means that before ECT, or lithium, or paxil, a patient needs to know what damage the treatment can cause. Even the very depressed deserve to know what they are getting into.

A Multiplicity of Madness

There has been some debate on a mailing list I am on about madness/psychiatric survivors/medical model and the best or the ‘right’ way of managing mental illness/mental health issues. It can get very contentious, and some people are vehemently opposed to one school of thought or the other. This is what I wrote in response:
For me the level of disagreement in the mad community about what the best/most acceptable/most useful way of dealing with madness is actually a good thing. This community is not monolithic, we are diverse and multifaceted, just like the rest of the population.
No person comes to madness on the same path. For some there is trauma and abuse, for others there is a less defined on ramp. In my mind there is also a place for biological components in some people. In some people, madness just is, and there doesn’t need to be a cause.
For this reason there can be no right way to manage madness. No one therapy or pill or school of thought will be the panacea. If you want to be a mad psychologist then that is awesome. There are some good clinicians who get it, and are compassionate and effective.
Painting the whole mad community with one brush is what average people do to us. It doesn’t work, and in the worst case scenario it means that some avenues of treatment or support get minimized because they don’t fit the model of the moment.
In the activist community I sense some of the resistance to people choosing the medical path. I say if you are really for choice and personal control over your life you should respect all the choices people make. If something doesn’t work for you, it doesn’t mean it can’t work for anyone else.
Madness is complicated. The responses should be as well.

I’m furious, and broke

It’s not even the end of the month, and the non-paycheck isn’t stretching as much as it needs to. I need groceries, I need to pay hydro and I need to pay for dental work.

The part-time job I thought I had fell through, and I know I am not really in good enough shape to look for another one. This one was perfect, doing work for a company I have worked for in the past with people I already know, doing things I already know how to do. The thought of trying to find some other place to take me on terrifies me right now. The whole process of applying, interviewing and landing a job is scary all on its own, but the thought of having to learn new people, new places and new procedures seems daunting and more than a little overwhelming.

I don’t qualify for welfare, because my husband works, and I am too functional for disability support, pittance that it is. Disability support wouldn’t even cover our rent, and the cost of moving is prohibitive all on its own.

I’m angry. Seething actually, that an intelligent, well-educated woman can’t support herself. My depression and anxiety are stopping me from going out and getting a job, and I can’t get any other support. I am beating myself up for being so useless, but on an intellectual level I understand that this is not really my fault. Intellect isn’t all it’s cracked up to be on this one.

I could hit up my family, again, but the humiliation is more than I can handle at the moment, and they have already gone above and beyond for me. The financial support they have given me so that I can go to school is much appreciated, but it always comes with strings. No matter how well-meaning they are, ‘suggestions’ about how I should live my life, and what my priorities – or my husband’s priorities – should be are not helpful and they make me feel like a child. Feeling like a child is not really conducive to improving my self-esteem and confidence.

Almost everyone I know with mental health issues is broke, close to broke, in debt or barely making it. Financial stability or at least some measure of security is important. Financial stress is one of the strongest influences on my mental health, and from my experience it is that way for most people. How is it that I am expected to be building myself up, strengthening my psyche and getting well while at the same time trying to figure out if I can afford milk?

I need a job to get better, but I need to be better to get a job. How is this going to work out? It’s not like I want the state to support me in a luxurious lifestyle. I’m not looking for a holiday, or a new outfit. I just want there to be some sort of short-term system that I can tap into for a few months to keep things going until I can get my act together. Medical EI? Yeah, that only works if you have been paying into it for a certain number of weeks, and my last job was contract so it doesn’t count. Catastrophic insurance? Also not an option, I don’t have any. No insurance company will cover me for anything related to my mental health because I have a pre-existing condition.

I know this is a lot of complaining, but realistically I am not alone in this. I see this happening over and over again to people I know. Poverty is a significant contributing factor in mental illness.

From The Canadian Mental Health Association (Ontario)

“For persons who are poor and predisposed to mental illness, losing stabilizing resources, such as income, employment, and housing, for an extended period of time can increase the risk factors for mental illness or relapse.”

We are so focused, in North America, on individuality, on personal responsibility, that we are putting people like me at risk of relapse. Relapse, for me, means possible hospitalization and that, as I have said before, is really expensive. Even beyond mental health issues we seem to be unable to focus on prevention.

We would rather punish people after they have committed a crime than put social supports in place to reduce the things, like poverty for example, that breed crime. We seem to be willing to risk the life and health of citizens to avoid paying for preventative programs. The mayor of Canada’s largest city just voted to refuse $300,000 in free federal funding to support at-risk kids. This in the same week as a gang-related shooting in a major mall that killed two people and injured several innocent bystanders.

We starve the system of support for seniors to the point where they can’t afford to stay in their homes and end up in long-term care or hospitals. Both are very expensive when compared to personal support workers and home care. That is not even taking into account the quality of life issues that arise when you hospitalize someone who would rather live out their life at home, or even in hospice. We don’t even have a system for supporting families that are trying to care for their aging parents and grandparents.

Other jurisdictions, including places like Germany and Sweden, have a philosophy of preventative intervention, of acting to prevent crises and expensive acute care or incarceration. Of course they are, gasp, more socialist and, double gasp, European, but really do I care what we call it if people get what they need? Sure Europe is in a financial mess right now, but not all of it is due to an out-of-control health care system, and Sweden and Germany are doing pretty well all things considered.

Out of personal interest I would like some income support, to get me through this rough part, to keep me from losing my marbles trying to feed myself. I would like it if disability support were not based exclusively on the premise that you will not recover, and if it were enough to raise a person above (or at least to) the poverty line. At a community level, though, I want more support for the vulnerable before they end up in crisis, not just out of self-interest, and not just for reasons of social justice (although that should count for a great deal). We can’t afford the health care system, the welfare system and the corrections system as they are set up now. You hear it in every budget speech, in every ‘austerity’ program proposed. If the system is broken – fix it! Look for lower cost alternatives like preventative measures, supportive measures, things that will allow people to get into, or get back into the work force. Don’t make us suffer to the point where we get acutely ill, or get into a gang, or end up in long-term care. That costs way too much in money and in human suffering.

Invest in people a little. Put some money into the system, up front, and in a smart way. It will pay off long term.

I’m hoping some person I helped out in the past will turn out to be fabulously wealthy, hate all their relatives and leave me their vast fortune. Realistically, it’s more likely than winning the lottery. I’m a nice person and have helped a whole bunch of people out over the years. Hey, it could happen!

Some of it will go to groceries, for sure. I would, however, spend a lot of it supporting people like me that just need a few months of cash to keep the roof over their heads while they figure out how to move forward. Yeah, I’m really hoping that little old lady who fell down the stairs in 1989 has a vast fortune, and an ungrateful nephew who is just out for her millions. I’m still hoping the people of Ontario and our elected representatives will wake the hell up and shake up their priorities, but given my level of pessimism right now a wealthy widow is looking like my best option. Sad.