True Cost of Mental Illness -- An Interview
According to the National Alliance on Mental Illness (NAMI), mental illness presents an important burden on resources, both personally and societally. Mentally ill patients have higher rates of death, usually due to suicide or accidental overdose. If they have chronic diseases such as AIDS or heart disease as well, the mental illness causes a poorer prognosis. Depression, schizophrenia, and other mental disorders can wreak havoc with a person’s ability to work. Lower productivity, absenteeism, and short-term or long-term disability are common. A mentally ill family member can increase caregiver burnout as well as disrupting normal family dynamics. Finally, mental illness, especially depression, and substance abuse (with all the costs it represents) are closely tied together. Undetected depression in substance abusers may be as high as 30 percent or more.
In order to further explore the costs of mental illness, I interviewed a mentally ill friend of mine (with her informed consent). For anonymity, I will call her Mary.
Anita: When did your illness began?
Mary: I actually think it began when I was quite young, but when I was 13 the symptoms became more obvious. My parents were divorcing and I was depressed. I expressed it through morbid talk, suicidal gestures, odd behavior at school, and self-injury. I went to a psychiatrist, who prescribed an antidepressant and a tranquilizer.
Anita: Did the depression affect your schoolwork or family life?
Mary: Definitely! I made my first D that year, in history, because I didn’t do a major project. I didn’t have any energy – also, I didn’t care. My grades were poor in other courses as well. I was in the orchestra, but one day I just walked out, went to the office and changed to become an office aid. I did many strange things like that. I was extremely withdrawn.
As far as my family, it was a big disruption. My mother, who was having problems of her own with the divorce, took me to the psychiatrist in the next town. I told her I hated her and didn’t want her to be my mom anymore. I blamed her for the divorce, and whenever I made suicidal gestures I wanted her to feel guilty. I also told my sister, “One of these days I might kill you.”
Anita: Wow. So how long did you see the psychiatrist?
Mary: About two years. As I got better, he took me off the pills gradually and pronounced me “cured.” I thought he was right; I felt great! Perhaps too great though. My moods cycled frequently from high to low. I think today I would be diagnosed with cyclothymia, a milder version of bipolar.
Anita: What happened next?
Mary: During my senior year of high school I developed another severe depression, but I kept it to myself this time. I became convinced I would die before graduation, probably from leukemia, since my father died from it and I believed it should have been me. Of course, I did not die, but the depression and fatalistic feelings continued through the summer and into college.
I coped with my feelings by ignoring my classes in favor of brooding and writing dark poetry, drinking alcohol, and having sex. In the spring semester I got pregnant.
Anita: What did you decide to do?
Mary: I placed the baby for adoption and worked to “get my act together.” Because of the depression, my first college experience ended up being traumatic for me as well as for my family. I wasted my freshman year of college and first semester of my sophomore year; this included losing a full scholarship to a prestigious school. My mother and stepfather had to pay for my room & board at the maternity home where I stayed. The pregnancy became a “family secret,” something no one spoke of because of the shame.
After the baby was born I went home and entered college there. Three years later, during which my mood swings continued but improved a bit, I had married and my daughter was born.
Anita: Did you finish your degree?
Mary: No, even though I only had one semester left. The post-partum depression made it impossible for me to concentrate enough to study and listen to lectures. Also, I was paranoid that something would happen to my daughter if I left her with a baby-sitter.
At this point, it is clear that Mary’s mental illness again disrupted her schooling, preventing her from graduating and entering the work force. Without a degree, she would never reach her potential.
In the next article of the series, I continue to interview Mary about the illness in her mid-late 20’s and early 30’s.
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