There are many unpleasant things about suffering from mental illness, particularly if you have one of the more severe forms like I do that can result in episodes of detachment from reality (only when my meds are out of whack, though).  One of those more unpleasant aspects of such an episode is that, just when you are most in need of a great deal of support from your support network, most if not all of it instantly evaporates.  As Elyn R. Saks says in her book The Center Cannot Hold about her experiences with schizophrenia, “When you go to the hospital for cancer, people bring you flowers.  When you go to the hospital for losing your mind, people don’t bring you anything.”

Sadly, that was my experience as well, and for a long time it made me very angry.  I had lived in the same city with largely the same group of friends I’d had for over 20 years, and with a single exception, I don’t recall anyone reaching out to me to see how I was doing after getting home from the hospital.  I know there were some who spoke to my husband, but by and large I was treated by others like a bomb that needed to be handled very gently.  That may have been out of respect and a desire not to do anything that might aggravate my condition, but the result was that I felt incredibly lonely, not to mention abandoned.  I didn’t necessarily want to talk about what had happened, and I don’t think anyone else did either, which was probably another reason people kept their distance, but the almost total absence of expressed love and support was striking to me.

That was all in 2019, and I’ve had a lot of time to mull over everything that’s happened related to my mental health.  I’m also a Buddhist, so I feel it’s my duty to view as much of life as possible in a compassionate light.  I knew that my friends and family weren’t assholes who didn’t love me, they just had no idea what to say because our society treats severe mental illness like a cockroach that needs to be killed, and quickly.  For most neurotypical people and a lot of neurodivergent ones as well, seeing someone in the throes of a manic or psychotic episode or a severe autistic meltdown is very frightening and evokes an instant “make it stop, NOW” response.  That is certainly how I was treated by mental health staff when I found myself in that scenario.

Our society also suffers from the false notion that there’s really nothing to do for such people besides make them take medication that itself often makes life unbearable due to the side effects.  Steady research on how trauma affects the brain and body since the 80s has proven otherwise, and people such as myself are doing what psychiatrists have always said was impossible: actually healing and recovering from some of the worst mental health symptoms that exist, mostly using methods those same psychiatrists repeatedly dismiss as being pseudoscience.

So after some compassionate contemplation, it was clear to me why no one talked to me after my hospitalization or even sent a “get well” card.  There are simply no guidelines for any of us when this happens to someone we know like there are when someone gets cancer or some other physical malady we’re more familiar with, and therefore more comfortable.  Within my own family, no one talked about it because it was a traumatizing event for all of us, and coupled with the lack of any social context, it was an intensely uncomfortable topic to bring up.  I still haven’t spoken to my children about it, nor they to me, and it’s only been in the last couple of years that relatively easy and brief talks with my husband have occurred about it.  We’ve even been able to laugh about some elements.

The obvious question is, what would make it easier for people around someone who has suffered a mental breakdown to talk to them?  Furthermore, what’s okay to say and what’s not okay to say?  I imagine that last one there is a big reason why the loved ones of the mentally ill simply choose to say nothing at all: out of fear of saying the wrong thing.  I can only speak for myself on this front, but I do best when I’m treated with the same gentleness one would treat a victim of a severe car crash who has broken bones and internal injuries.  A psychotic break bad enough to send you to the hospital is essentially the mental equivalent of such and will take the same kind of care, attention, and time as the car accident victim will in order to recover.  In fact, it may take more time and care.

What do I like hearing?  Simple questions, such as “how are you doing today?”; “have you eaten lately?”  Simple statements of affection and affirmation, such as “I love you.”; “I’m glad you’re around.”  Depending on how I’m feeling, I may or may not respond, but I always hear it and it makes an impactful difference.  Reminders to do things I enjoy are also good to hear, because I’ll forget for whatever odd reason.  Gentle cajoling to do things that are good for me is also welcome.  Just make sure the tone of voice is caring without being infantilizing.

What do I not want to hear?  Any and all implications that my behavior, thoughts, or feelings may somehow be tied to my mental health, especially since I devoutly adhere to taking my meds.  This is where other people can get tripped up by their own subconscious feelings.  They may not consciously view me through a biased lens, but they do it subconsciously and it shows in their tone of voice, their body language, and their facial expressions, especially the eyes.  I have become very familiar with what I call The Look, a facial gaze that tells me the other person is listening to me through filtered ears because of what they know about my mental health.  It’s been very disappointing to encounter this, but I try not to hold it against people because I know why it’s happening.  By the same token, part of my healing process is only associating myself with people who can accept me as I am without judgment, and The Look is a judgmental look at heart.  Perhaps they think they’re coming from a place of concern, but that’s not how it comes across.

On the subject of meds, that’s another big no-no to talk about where I’m concerned, at least from the perspective of “are you taking them?”  Of course I’m taking my freaking meds, you think I want to wind up taking another grippy sock vacation?  That’s probably a good rule of thumb for anyone with any kind of mental illness, from the mildest anxiety to the severest schizophrenia: don’t ask about their meds, let them bring them up if they want to.  They may not be taking any and have a perfectly valid reason for doing so.  They may also have a morning and evening medication cocktail requiring a martini glass fit for James Bond and also have perfectly valid reasons for that as well.  Either way, unless they bring it up, it’s not your business.  If they do bring it up, express only positive support for their choice, even if you think it’s the wrong one or have a whole list in your head of alternatives they could or should try.  From what I’ve observed about the general chronic illness community, which includes mental illnesses, it’s fairly gauche to start throwing health advice at someone who reveals they have a health issue of any kind.  Chances are they know more about it than you do unless you also have that issue.

I rarely talk about the actual events of my breakdowns except perhaps with my husband, who was present, and that’s because of the tremendous amounts of shame and embarrassment that go along with those events for me.  Occasionally it’s funny now, which I think my therapist would say is a sign of healing, but mostly I still feel like I’m recovering from some kind of bizarre and epic 10-day drunken binge during which I made a complete fool of myself in too many ways to count.  That may be even worse than the way your social circle shrinks back: the ‘I did what??!!’ feeling that sets in as the psychosis or mania wears off and you either remember or are told what happened.  

Ever feel so embarrassed and ashamed about something very public that you wanted to shrink into your own belly button and disappear?  Multiple that feeling by a thousand.  It doesn’t matter if it was an audience of one or a hundred, the feeling that comes with completely losing it in front of another person you know very well is indescribable, and not in a good way.  I know there are things about my experience that I don’t remember that my husband has also not told me, and by now I’m fine with that.  If my subconscious is withholding that information from me, it’s for a reason.

I see now that is probably a huge reason why my loved ones didn’t reach out, aside from just not knowing what to say in general: not knowing how to talk around information they knew I might not take well in the aftermath.  I had already been through enough, there was no reason to upset me with anything bizarre or frightening I may have done or said.  That wasn’t the real me, so why bring it up?  If this was the case for my loved ones, then I feel bad for being angry about their silence.

Still, a gentle modicum of support would have been nice in the form of messages, texts, or cards (and yes, flowers: bright colors always cheer people up).  Which is not to chastise my loved ones but to offer future guidance should the issue come up for my readers.  You can’t imagine the dark place that awaits the person whose mind breaks like that.  Even the smallest light offered in the form of a “hope you’re feeling better” can be the thing that actually makes them feel better by driving back the darkness, especially in a society that only wants them to stay in the dark, be quiet, and take their pills.

It’s important to remember that continued trauma research is revealing that the vast majority of people who suffer from the most severe mental illnesses have traumatic backgrounds of one kind or another, with childhood abuse being the most common (raises hand).  These people have already been through hell, resulting in the eventual breakdown of their minds, and they do not need more of the same treatment that made them that way in the first place, which is sadly what is received at too many mental hospitals as well as in society.

The stigma attached to having a severe mental disorder is staggering.  People like me encounter discrimination at every level of our existence, even in the healthcare system (sometimes especially in the healthcare system: ignorance is ubiquitous).  When we encounter it in our social circles, it is painful in a way that cannot be described, and if it could be, would there be any point?  Those who were supposed to be your tribe have retreated from you just when you needed them the most.  What is the most important thing that the mentally ill not hear from those who claim to love them?

Silence.