The Thing About Mental Illness

Editor in Chief

We have all been thrilled with the response to our first essay contest, in which psychiatrists wrote about experiences with patients that had a profound effect on their careers. One of the aspects of the prize-winning works, the first of which were published last month, is the central importance of listening empathically to our patients. To emphasize this point, I thought it would be important to publish a piece from someone who has been personally affected by a psychiatric problem. To hear from the person on the other side of the interaction.

This month I share with you an essay written by Sam Pillersdorf, who was the winner of the prose award from the Depression and Bipolar Support Alliance (DBSA) in my home city of Louisville. I was present and deeply affected when Sam read her prize-winning work, “The Thing About Mental Illness,” to the audience at the celebration of all the winners of the various categories in the DBSA art contest, which included visual, written, and performance art.

Her description, at once poetic, raw, and haunting, of her experience of having a psychiatric illness is so powerful in revealing what I believe are common, but rarely articulated, thoughts and feelings that I asked her permission to publish her essay in Psychiatric Times. Sam, who works as an Adult Peer Support Specialist at Bridgehaven Mental Health Services, a wonderful community-based and recovery-focused program in Louisville, quickly gave her approval. I often think about her and what she expresses in her writing, and it has influenced my work with every patient I’ve seen since then. I think you will be changed too.

The Thing About Mental Illness

Sam Pillersdorf

The thing about mental illness is-it’s this: it’s that it sucks. That it’s terrible. That it’s deeply and profoundly unpleasant and even if it’s not due to a particular, single symptom to begin with, it makes you hate yourself because it’s your mind that’s sick. And if you aren’t your mind, who are you?

Other than often feeling completely and utterly miserable; other than being the stupid asshole in the back of class who can’t decide whether they’re there to learn or while away the time until they inevitably end their life; other than a mess of blood and entrails and squishy gray bits to dump out on an autopsy table and poke through with needle-knives and forceps after the “accident” that ended it all; other than all of that, the only part of you that can’t get shot or torn apart, can’t explode into red mist and bone shards, is mind. And when that’s diseased, where are you? What would Rene Descartes have to say about this? About you?

You think; you are a thinking thing. You are a thing. You exist, you are necessary. And as a condition of consciousness of yourself, you know there must be a self, an object made of consciousness. And that object, you are now told, is malfunctioning. It is unwell. It is ill. There is a disease, a sickness, creeping within you; in your thoughts, your mind, your consciousness, your self; your uniform, indivisible, nonphysical self.

You cannot mix souls. You cannot dilute them. You cannot infect them. This is you, eternal, essential, we’re talking about here. If it is diseased, then you are diseased. If it is diseased, you are disease. Disease is not a part of you; it is you. It is of you. It is part of you only in that every other thing about you is part of you. It is as much a part of you as your eyes or your brains or your intellect or your nerves or your curiosity or your affections or your words or your fear.

If your mind is sick, is ill, then you are that sickness. You are illness. You are unclean, you are impure. No, wait. You are not merely unclean or impure, you are uncleanliness, impurity. You are the filth that they say infects you. You are what the doctors say is wrong with you. You are what’s wrong. You are wrong.

The scaffolding that creaks and sways over black, black waters; the hard, gray space that’s infinite and claustrophobic and cold; the long, long hallway with its hundred locked doors and the telephones ringing unanswered into silence. Those are the metaphors, those are the illness; they are every dark moment and every bad feeling you have ever in your life experienced. They are pieces of you, parts of the indivisible whole; they are you.

You are the megaphone that has been cast down beside a chasm too deep and cold for warm words to penetrate; you are the nerveless specter in a crowded room, the ghost that sees and is unseen, that is jostled and feels nothing. You are everything you have been promised you are not and you cannot blame Descartes.

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That you are ill is in dispute. What is dysthymia? A level below the norm, a state best characterized as simple moodiness. Ninety-nine percent of your symptoms have been, quite rightly, written off as irritating defects of personality. Who in G-d’s name would consider grumpiness or a disinclination toward letting things be a sign of sickness?

You are unpleasant, not depressed-or, if you are depressed, you think it is at least half your own doing. How can you expect to be anything else when you insist upon contemplation of such horrible things? Upon thinking, upon writing, upon dwelling upon such things as this essay? And, as any amateur psychologist could tell you, talking yourself into sorrow does not depression make. All it makes you is an asshole, likely one who is desperate for attention.

All of which is either irrelevant or completely relevant to my original point this is what my depression is like. This is mental illness. This is what it’s like in my head, every hour, every day.

The occasionally excessive enthusiasm, the extremes of focus on murder mysteries or philosophy or the subject at hand are, as much as anything else, attempts to make my own brain shut up for a minute. Or to at least talk about something else, anything else, anything but expressing for the tenth time in as many minutes that I am a fraud, I am pathetic, I am stupid and cowardly, and not sick at all; just fundamentally deficient, incapable of properly handling things (things like conversation and city streets and compliments and errors and being suddenly addressed and friendship and affection and the necessity of just stopping already, who the hell do you think cares, you sniveling waste of human flesh and space), and that I ought to but can’t even blame it on being made wrong because that would lay the fault elsewhere.

It’s as though there’s something missing that would make me whole, that would make me worthwhile even to myself. But it’s not that it was left out, it’s that I lost it, or squandered it, and it’s my fault. It’s my fault anyway, that I’m not enough, that I never have been, not enough for anything. And since I’m not whole I might as well not be, the waste and ruin of material is worse than a blank space would be and this is what I mean. I didn’t mean to do that; it’s just what my mind does.

And it’s still doing it; it’ll keep doing it, since it’s never yet found cause to stop. This is the buzz I talk about, the monologue, the litany of self-hatred and anxiety. There’s a fallacy in it; a clear, named logical fallacy but that is of precisely no comfort when I still believe it wholeheartedly, when its own flaw can only be a sign of its truth: I can’t even get self-hatred right.

I’ll try to keep a handle on it, now, to keep it from getting away from me. I’ll try not to let it go. It can’t be fun for you to read this any more than it’s fun for me-not to think but to be.

And, yes, that’s it, that’s the point, there it is: this is a part of me. In some at the base, fundamental sense, this is me. And it is a very, very bad thing to be. There’s nothing glamorous about it, nothing romantic. There’s only a kind of blank, boring misery that hurts your stomach and distracts you from all else; a feeling of helpless humiliation that lingers because you’re doing something wrong and everybody can see it but you. (And they’re laughing at you, probably, but you’re flattering yourself when you think they even notice, that they would bother to notice, that they would care if they did.)

And it is boring. If you aren’t bored already reading this, imagine reading nothing but this, over and over, every minute of every day, from the moment you open your eyes in the morning to when sleep finally overtakes darkness at night, and think how sick of it you would get. Think how unpleasant and angry and ineffectual you would feel, because there’s just this, just hate and frustration and unhappiness and there’s no way you can make it stop, no way you can change it. Even a new page to read or a new reason to hurt would be an improvement because at least then you wouldn’t have to listen to the same shit, over and over and over again.

So, yes. That’s it. That’s the thing about mental illness. It’s unpleasant. It’s boring. And it hurts. So, so much.