When Mental Illness Becomes a Friend
By: Natalie Frank
Tags: Relationships, Mental Health, Mental Illness, Mindset, Psychology

I have read several articles today composed by writers who seem to be wondering why people who have mental difficulties making them miserable don’t do something about it. It doesn’t come across as intentionally judgmental or critical, but seems more like genuine confusion as to why these individuals don’t appear to want to change things so their lives improve.

In one article, the writer asked about a friend. “They were so competent before, I mean like uber-competent. They have two Masters, a Ph.D. and an M.D. How is it possible that someone like that doesn’t seem able to fold the laundry or clean up? It’s almost like they don’t even realize these things need to be done or maybe like they don’t care anymore.”

In another article the question was, “Do depressed people somehow lose the desire to be happy or do they just not know how to achieve this? It seems like they just aren’t interested in being happy anymore.”

I wanted to try to answer these questions as many people don’t know or understand just how much mental distress affects people. Yet the question about them not wanting to be happy is also an important one to address. There are a few truths to discuss about this matter.

There is a difference between transient symptoms we all have and chronic, more severe symptoms that are part of a mental health condition.

When I teach abnormal psychology, I make the statement that most mental disorders are just more extreme versions of what we all experience in a more moderate way. So we all know what anxiety or depression feels like although for most people it doesn’t reach the level of being considered a disorder. While this is the case, there is a difference between what we all experience and what those with a significant problem in this area experience.

This is because when these things last for a long time or become chronic, they wear people down. This affects their immune system, their beliefs about themselves and the world, the degree to which they can maintain a social support network and whether or not they can take part in activities they once enjoyed. Thoughts that are in line with the disorder also occur when it lasts a long time. For example, people with depression often have thoughts related to worthlessness, hopelessness and pessimism.

The difference between passing symptoms and long term, severe symptoms also occurs because of the person’s mindset. When mental health issues can be associated with a cause such as failing a class, breaking up with a significant other or other similar life events the person usually doesn’t think that the resulting problems will be part of their life permanently.

They understand their altered mental health is the result of something that other people go through and get over and expect to do the same. Those with chronic mental health problems, though, don’t necessarily associate them with any particular life even even when there is one, and while there is always the hope they’ll get better, a big part of them doesn’t really believe it.

The stigma associated with mental illness also lead to difference between milder, transient symptoms and longer duration, mental health issues. The messages that people hear about mental disorders such as they indicate a person is flawed or weak can be internalized by those experiencing more chronic problems and this can lead to a worsening of symptoms. At the same time, even given how distress these problems may be, sometimes the person may feel some reluctance when considering being cured.

Sometimes it can just be too much to do even the simplest of things.

It struck me how much this is the case, when I read an article written by Erika Sauter, called Letters to Friends and the Motherfucking Sad. She describes what it’s like to not be able to do every day activities even when there’s not much to them. For example, she describes the difficulty she has folding laundry.

“I should fold it and put it away. I don’t because I don’t have it in me today, the same as the day before and maybe not tomorrow, either. I turn around, walk back up the stairs and plop myself on the couch.”

It’s not that she isn’t able to do this or doesn’t know how. While people who are depressed due to a life event that will pass may feel down in the dumps while they are doing what they need to do, or maybe leave something for the next day, those with serious depression can’t bring themselves to carry out normal daily activities. Garbage may pile up on counter tops, cleaning may not be done for weeks, packages may remain where they were first put down for months, but although the person knows these things need to be done they just can’t. They tell themselves they’ll do it after a break, tomorrow, when they are feeling better, but days run into weeks which run into months and nothing changes

Often with mental health issues, passions still exist if only for brief periods. The memories of these passions and the dreams that made life exciting are still there even if the same degree of

Sometimes a person with a mental problem may still feel a passion for something but be unable to engage in it.

Often times with mental health problems, an individual no longer has the desire to do things they once enjoyed. Sometimes though, the person still has moments when old passions for certain activities return or at least has very strong memories of what it felt like to have those passions.

When the person tries to engage in the activity they were once passionate about, even during those times when there’s a glimmer of the old desire, they just can’t quite manage it. The inability to do what they once loved, just adds to the problem. There may also be the thought that if the time they’ve wasted when their problem has prevented them from doing much of anything, had been used in pursuing their passion they could have accomplished something remarkable. Instead, they feel even worse about themselves, and may be convinced they’ll never be able to do the activity again.

Is It Always All Misery Though?

I think the answer to this lies in how you define misery. This is because even with everything I said above, that the problem becomes familiar and thus, on some level, safe. When you feel a certain way for a long time, even if it’s not a positive one, it starts to become normal. Even though there is a desire to give it up and have a happier life, at the same time, the thought of doing so can be scary because it is unfamiliar. The problem itself may even be seen in some ways as positive.

In the article mentioned above, the author says:

“My mind suffers from agoraphobia and my body from depression. There’s an unspoken beauty where the calmness meets the chest crushing pain. Sometimes people feel sad because I’m sad, but there’s strength in sadness. Depression does rob me of self worth and life experiences, and the belief that some day I’ll prevail but it also provides the ability to live in the moment. Mindfulness. Depression is the gift of mindfulness. It’s not so bad for me, you know?”

I took this to mean that when those moments of calm arrive they are practically miraculous when compared to what the author calls the “chest crushing pain.” And even though the depression robs her of hope that she’ll ever be free of it, the inability to focus on the future means that she is able to live in the moment, something she perceives as positive. “It’s not so bad for me, you know?”

Sometimes, because of the familiarity and talking themselves into the idea that there are positives to the problem, the person can have a part of them that doesn’t want to give it up. I can remember treating a man with schizophrenia who had an amazing response to medication and therapy. The symptoms disappeared he was able to fully get back into life.

He got a good job and started started participating in social activities and making friends. He rented a nice apartment, off the street for the first time in several years. He continued to improve over the three months that I worked with him and I can remember leaving that rotation thinking he was definitely one of the success stories.

I was stunned to find out only a month later from the intern who had taken my case load for that rotation, that the patient was off his medication and back on the street. There was an outreach team who tried to help the large number of mentally ill homeless people. They took me to where the patient slept and I convinced him to come in to see me for one session.

Though his psychotic symptoms were back he could still explain why it was he had given up all the improvements to his life. He said that he didn’t know exactly how to navigate the “new world” he experienced off of his medication, so even though life on the streets might have been harder it felt more familiar. He added that while “normals” might think that what he referred to as his “psychotic world” might seem chaotic, unpredictable and frightening, it was what he’d known for over 20 years and he missed it when the medication caused it to disappear.

Take Away

It can be hard for people who have never had serious mental health issues to fully understand what it is like for those who have. Even though it may seem like we understand what chronic depression or anxiety feel like because there have been times we felt depressed or anxious, the truth is it is a very different experience for the people who suffer from these types of problems long term. It’s important to recognize that unless we have had to contend with a similar difficulty that wasn’t situational or short term we can’t assume to know what it’s like for those who have a disorder.

It may not make sense to us how a mental problem that prevents someone from taking care of even the smallest of chores or from living in the real world can be viewed as having any positive parts. It may seem counter-intuitive that someone may feel ambivalent about getting better. It’s important to accept those with these types of problems on their own terms and meet them where they are, not where we expect them to be. Doing this in a supportive manner is the best way to help them not have to deal with feeling as if they are isolated from caring others in their life as well.

Thanks to Erika Sauter for inspiring this article.