I used to think of mental illness as having an enemy inside my own head who hated me and wanted me dead. It was my nemesis; inextricably linked to me, but not me. I subscribed to a 19th-century concept of mental illness; it was something that alienated me from my myself, whatever “myself” was.
It was only with some time, distance, and good luck, that I was able to look back and consider there might not have been an enemy inside my own head at all. I spent my late teens and first half of my 20s speaking to different medical professionals, trying different medications, a course of cognitive behavioural therapy (CBT), psychotherapy and talking therapy. In all this time, no one had asked me to consider the material realities of my life, and how they were not just exacerbating, but creating my issues.
I was officially declared “Bipolar with a side of BPD [borderline personality disorder] and a generalised anxiety disorder” at the age of 22. Some of my symptoms didn’t fit these labels, but that didn’t seem to matter. Furthermore, no method of treatment seemed to work, but this was put down to problems with my inscrutable brain, rather than the diagnoses themselves.
I was constantly told that I shouldn’t expect a cure, that these were chronic conditions to be “managed” for the rest of my life. The year that I stopped displaying any symptoms, when the hellish, almost decade-long cycle of depression, mania, and episodes of anxiety, psychosis and a general feeling of being out-of-control ceased for apparently no reason, I analysed my life to find out what had changed. Only two things had changed: I had stopped dating, and my financial situation had become more secure.
In the years before and since my official diagnoses, I was in a series of relationships that ranged from emotionally abusive to physically abusive. Due to how hard it is to make a living wage from writing, my finances and housing were precarious. I also had several part-time jobs on top of what was meant to be my livelihood. With all this in mind, years later I find myself marvelling, with increasing anger, at how anyone could have told me that my problems were all in my head. How many more people are labouring under the idea that their mental health issues can be put entirely down to brain chemistry, without environmental factors being taken into account?
Many of my friends with mental health issues have been prescribed a course of CBT at some point during their journeys through the system, because – despite its low success rate – CBT has become the one-size-fits-all of treatments. My course of CBT mostly focused on getting me to recognise the irrationality of my triggers, which is impossible when you know your reasons for feeling a certain way are not irrational. During a conversation with her therapist, a friend of mine discovered that it has only recently become standard practice to stop treating all anxiety triggers in the same manner. More therapists – though not enough – now recognise that if your anxiety or depression is triggered by a relationship, worries about money, insecure housing, losing your job, your physical health, grief, or obsessive-compulsive disorder (OCD), then being treated as if you’re irrational is little more than medically sanctioned gaslighting, and will actually make your mental health worse.
So what is the cure? Undoubtedly, we need better mental health funding, but what will more funding achieve in our current context? It seems almost flippant to claim that all of my problems could have been solved with money, but almost all of them could have been. Nothing could have made these tangible, material problems better aside from a sudden influx of money.
Without money, women can’t afford to leave abusive relationships. Without money, we can’t leave bad housing, and there is a lot of bad housing, given the UK’s government voted down legislation requiring landlords to make their properties habitable. Without money, we can’t access the therapy we actually need, instead languishing on NHS waiting lists for sometimes years, awaiting a course of group therapy, involving individuals with a variety of problems that demand radically different treatments. If your job is making you ill with stress, taking as much sick leave as you need can result in disciplinary action, yet you also can’t leave without excess money (or an increasingly scarce secure job to go to). Due to skyrocketing living costs and stagnant wages, excess money is something most people don’t have. And so many of us carry on surviving, dragging compounding traumas and anxieties to ever-worsening situations. It’s good to talk, vital even, but self-awareness alone isn’t making our world a better place in which to live.
Therapists often talk about about self-awareness and integration as if we simply haven’t thought about our own problems enough. There is more than a whiff of positive-thinking ideology about it. While resilience to negative situations is essential to survival, as is the development of healthy coping mechanisms, many of us have already cultivated more resilience than should be necessary in any society that calls itself civilised. I once had a male therapist completely shut down my train of thought after I suggested that some of my problems have been worsened by my everyday and painfully routine encounters with misogyny. The reason people of colour are unable to talk about the detrimental effects of racism with white therapists should be obvious. A lack of access to money, secure housing and secure employment also affects marginalised people with more severity. A lack of resilience then, is not the origin of our problems.
To write my fourth novel, I used the last of my money to move to a city where I knew barely anyone, and could afford the rent. Because if I didn’t enforce my solitude, if I didn’t write something good enough by the time that money ran out, I didn’t have a Plan B. I began waitressing again, because by the time I finished a first draft I couldn’t afford to move back. On the face of it, the story of how I wrote my fourth novel – which I was lucky enough to sell for my first comfortable yearly salary – could resemble a heartwarming success story. It could readily be used to justify the trope of the suffering artist; the idea that we produce our best work when experiencing hardship. The truth is, we don’t. It’s a dangerous myth used to systematically devalue artistic labour. Part of being self-aware is recognising the roots of your successes as well as your problems, and I recognise that I’ve produced my best work despite the hardships, not because of them. Furthermore, hard work and resilience often amount to nothing without an intervention from luck.
And luck can end a life as well as start one. We live under a predatory capitalist economy designed to grind people into dust if they suffer one bout of bad luck; sickness, a bereavement, redundancy, abuse. What would have been the value in realising the material causes of my mental health problems if I’d never found the money or safety to allow me to begin healing from them? How can we continue to advise people to “reach out” when there is often nothing worth reaching out to? How can we encourage people to cultivate a healthy amount of self-worth when human life and health is worth so little to the institutions that govern us? As I write this piece, the NHS is currently threatening someone I know with dismissal for taking time off due to chronic illness and stress. The irony of that cannot be overstated here.
Hanna Jameson is the author of The Last, published by Viking (Penguin), £12.99