Living Long-Term with Mental Illness

We would – of course – like any encounter with mental illness to be as brief as possible and, most importantly, to be isolated and singular. But the reality is that for many of us, the illness will threaten to return for visits throughout our lives, it will be a condition to which we will be permanently susceptible. So the challenge isn’t to learn to survive only a one-off crisis; it’s to set in place a framework that can help us to manage our fragility over the long-term. Some of the following moves, practical and psychological, suggest themselves:

Acknowledgement

Being ready for a return of the illness will help us to calibrate our expectations and render us appropriately patient and unfrightened in the face of relapses. We fell ill over many years – our whole childhood might have been the incubating laboratory – and it will therefore take us an age until we are impervious. We should expect to recover no more speedily than someone who has damaged a limb and probably a good deal more arduously, given how complicated a mind is next to a femur or a tendon. 

Vigilance

We’ll need to monitor ourselves with special care, vigilant for signs of deterioration and vortices of despair. Our minds are prone to amnesia, we forget what we have learnt about ourselves and what has kept us steady. We may have worked out the basic structure of our illness in therapy. We might know that we are prone to self-sabotage, that we carry a trauma with us from the past, that we are inclined to destroy everything that is good about our lives and alienate those who want to care for us. But such knowledge will always be vulnerable to destructive impulses that can sweep away our patient intellectual labour and catapult us back into a state of helpless and frightened infancy. We should be ready to be submerged like this – and not experience our retreat as a humiliation, confident that ebbs and flows are normal and that we will be able to hold on to at least some of our gains.

Repetition

Our minds don’t just need good lessons, they need to learn good habits, that is, they need to fashion routines in which helpful rituals, activities and ideas are repeated until they become second nature. Like someone learning a new language, we need to go over certain points again and again, rehearsing notions of self-love, self-forgiveness, kindness and self-acceptance on a daily basis. Things are so slow because we aren’t just trying to acquire intellectual concepts (something that might only need a minute), we’re trying to alter our personalities. It will be a life’s work.

Mental Management

We need to be rigorous with our patterns of thinking. We cannot afford to let our thoughts wander into any old section of the mind. There are thoughts that we need to nurture – about our worth, about our right to be, about the importance of keeping going, about self-forgiveness. And there are thoughts we should be ruthless in chasing out – about how some people are doing so much better than us, about how inadequate and pitiful we are, about what a disappointment we have turned out to be. The latter aren’t even ‘thoughts,’ they have no content to speak of, they cannot teach us anything new. They are really just instruments of torture and symptoms of a difficult past.

A Support Network

A decent social life isn’t, for the mentally fragile, a luxury or piece of entertainment. It is a resource to help us to stay alive. We need people to balance our minds when we are slipping. We need friends who will be soothing with our fears and not accuse us of self-indulgence or self-pity for the amount of time our illness has sequestered. It will help immensely if they have struggles of their own and if we can therefore meet as equal fellow ailing humans, as opposed to hierarchically separated doctors and patients. We’ll need ruthlessness in expunging certain other people from our diaries, people who harbour secret resentments against us, who are latently hostile to self-examination, who are scared of their own minds and project their fears onto us. A few hours with such types can throw a shadow over a whole day; their unsympathetic voices become lodged in our minds and feed our own ample stores of self-doubt. We shouldn’t hesitate to socially edit our lives in order to endure.

Vulnerability

The impulse, when things are darkening, is to hide ourselves away and reduce communication. We are too ashamed to do anything else. We should fight the tendency and, precisely when we cannot bear to admit what we are going through, we should dare to take someone into our confidence. Silence is the primordial enemy. We have to fight a permanent feeling that we are too despicable to be looked after. We have to take a gamble on an always implausible idea: that we deserve kindness.

Love

Love is ultimately what will get us through, not romantic love but sympathy, tolerance and patience. We’ll need to watch our tendencies to turn love down from an innate sense of unworthiness. We wouldn’t have become ill if it were entirely easy for us to accept the positive attention of others. We’ll have to thank those who are offering it and make them feel appreciated in return – and most of all, accept that our illness was from the outset rooted in a deficit of love and therefore that every encounter with the emotion will strengthen our recovery and help to keep the darkness at bay.

Pills

We would – ideally – of course prefer not to keep adding foreign chemicals to our minds. There are side effects and the eerie sense of not knowing exactly where our thoughts end and alien neurochemistry begins. But the ongoing medicines set up guardrails around the worst of our mental whirlpools. We may have to be protected on an ongoing basis from forces inside us that would prefer we didn’t exist.

A Quiet Life

We may – in our stronger moments – want to take on the world again and revive our largest ambitions. We should be careful of our motives. We don’t need to be extraordinary to deserve to be. We should see the glory and the grandeur that is present in an apparently modest destiny. We are good enough as we are. We don’t need huge sums of money or to be spoken of well by strangers. We need time to sort out of our minds and peace to stabilise our nerves. There must be free hours in which we can process our feelings, lying in bed or in the bath, soothing our frightened minds. We should take pride in our early nights and undramatic routines. These aren’t signs of passivity or tedium. What looks like a normal life on the outside is a singular achievement given what we are battling within.

Humour

There is no need for gravity. We can face down the illness by laughing heartily at its evils. We are mad and cracked – but luckily so are many others with whom we can wryly mock the absurdities of mental life. We shouldn’t, on top of everything else, accord our illness too much portentous respect.

Small and Big Wins

Many of the steps we take towards recovery could appear relatively small: a week in which we have not denigrated ourselves, a relationship in which we are allowing ourselves to to enjoy kindness, a peaceful sequence of evenings… The temptation might be to brush off these achievements a bit too lightly for our own good. Given what we may have gone through, these are milestones that deserve celebration and commemoration – so that we can notice how far we have come and gain strength from a glance back at the peaks and troughs of our mental lives.

We can think in this context of the work of the English walking artist Hamish Fulton. Fulton has spent his long career turning out large black and white photographs of places in the world where he has gone walking. Some of these walks have been epic in scale (whole weeks spent trekking across the Himalayas and the Andes), others have been more domestic (a few hours in the Welsh mountains). But Fulton always accompanies his images with solemn text, a written record of where he has been, how many miles he went and how long it took him. He arrests a moment that might ordinarily be lost and lends it weight and dignity. Through immaculate lettering and sober photography, Fulton is signalling to us how much a walk may – when fairly be viewed – be life-changing, and as worthy of commemoration as a battle or a premiership.

One could imagine performing a similar exercise of commemoration on the business of recovering from mental illness. Here too there are plenty of moments that are quietly extremely arduous and important – and that would warrant being frozen and highlighted. We could picture a vast photograph of an ordinary bath-tub to which a caption might say: ‘May 12th, evening, two hours of soaking, rethinking my relationship to what other people think.’ Or a picture of an armchair by a window: ‘September 3rd, an hour reflecting on my right to be free and content.’ A shot of an unmade bed at night might say: ‘An evening of self-forgiveness.’

We should be proud of ourselves for making it this far. It may have looked – at times – as if we never would. There might have been nights when we sincerely thought of taking our own lives. Somehow we held on, we reached out for help, we dared to tell someone else of our problems, we engaged our minds, we tried to piece together our histories and to plot a more endurable future – and we started reading about what might be up with us. We are still here, mentally ill no doubt at times, but more than ever committed to recovery, appreciative of the light, grateful for love, hungry for insight and keen to help anyone else whose plight we can recognise. We are not fully well, but we are on the mend and that, for now, is very much good enough.