One of the reasons it can be difficult to talk about mental illness is the simple fact that so many diagnoses feel poorly defined, or that just when our understanding of terms starts to stick in the public consciousness experts change the game on us, or that those of us with mental illnesses seem to collect diagnoses like Pokemon. Staying on top of the proper terms for mental illnesses or the latest consensus on what those illnesses even are can be frustrating and exhausting, and I get that. It’s even more difficult for us who are having to deal with it.
I’ve said this again and again, but one more time for the folks in the back: the brain is a tremendously complicated organ and our understanding of it is limited for a number of reasons. It can be really hard to know exactly what’s going on in there in real-time, or to concretely map activity in one area of the brain to a specific function. Even when an area of the brain or a neurotransmitter is isolated and understood, the interaction with other areas of the brain shade those known functions to a degree that it gets…murky knowing how one part of the brain influences another. Our ability to gather information about the brain directly is restricted — and rightfully so — by our ability to poke around within it and get feedback from the volunteer. And with something as subjective as personal experience, how can we assign a concrete, scientific measurement to self-reported data?
These are huge challenges that don’t have an easy solution, but scientists work hard to find every scrap of information they can. Through that work, we’ve come to understand a lot more about how the brain works and that’s resulted in a radical shift within the psychiatric disciplines. Filthy, poorly-run sanitariums are a thing of the past, and we now know mental illness affects large segments of the population who nonetheless manage their symptoms to lead productive lives. We have a range of treatments, from medication to talk therapy, that we can lean on to learn how.
Over the past several entries, I’ve talked about my personal experience with Major Depressive Disorder, Generalized Anxiety Disorder, and Attention Deficit Hyperactivity Disorder. Each one of these disorders affects my life in distinct ways, but together they interact with one another in ways that make it much easier to fall into a destructive loop. Comorbidity, in psychology, is the term we use for the presence of multiple disorders in one individual — but it’s also a term that points to the lack of concrete understanding for the underlying causes of many disorders.
Comorbidity frequently occurs because the cause of one disorder can also affect other aspects of the way our brain functions. For example, increased amygdala activity has been noted in individuals with both depression and anxiety disorders; it’s possible that what started out as an anxiety disorder became depression due to an individual’s experience struggling with one issue, or a lack of help, or the effects of anxiety disorder such as isolation, sleeplessness, poor diet and exercise.
Because of the way we classify mental illnesses, and the fact that it can often take a long time before a proper diagnosis is made AND proper treatment begins to take effect, it’s a fairly common thing for comorbidity to occur in those of us with mental health issues. Major Depressive Disorder, for example, is often the first diagnosis and subsequent ones are found through the course of treating it. I learned about my Generalized Anxiety Disorder and ADHD through talk therapy for my depression, when I spoke about my fear about stepping into a new position at my day job, my certainty that I would screw it up somehow.
I’ve thought a lot about the nature of my mental illness, why it’s happened to me. I’ve mentioned that my biological mother was diagnosed with paranoid schizophrenia when I was very young, and I only found out about it as a teenager. For years I was terrified that I would become schizophrenic too, that I would slowly and steadily lose my grip on reality over time. Living through the effects of that myself, and seeing how similar ailments like Alzheimer’s Disease and dementia affect a patient’s loved ones, that kind of progressive and incurable deterioration is still something that keeps me awake at night. The idea of losing myself to a disease that could make me hostile and cruel to the people I love the most is the scariest thing I could imagine for myself.
So I’ve done a lot of digging. I know now that the children of schizophrenics are genetically predisposed to other mental illnesses and yes, do have a higher chance of being schizophrenic themselves. It’s why I’m comfortable saying that my mental illnesses are largely biological; my brain is simply wired differently and that’s something I can’t help. But it’s not the only part of the story. Your environment and experience plays a tremendous role in whether or not these issues develop.
One of the big theories that I find really compelling is the idea of mental resilience — that the mind has variable success with bouncing back from traumatic experiences. If, like me, there’s a predisposition towards depression or anxiety, then these kinds of experiences make it much more likely for that to happen. Someone who is more neurotypical might be able to absorb that kind of trauma better and recover more quickly — again, that’s not guaranteed, but some might be better psychologically equipped to deal with really stressful times.
This is why it’s such a dick move to tell someone to “just get over it” if they’re struggling to recover from a bad experience. For some of us, it might be psychologically impossible to do that without help or a significant amount of time and effort. We might have the ability to absorb some stressors better than others as well, or we might have been marinating in a stew of stress for some time, barely keeping above it before something causes us to sink.
I know that in addition to my genetic predisposition, I’ve had a number of experiences that have knocked me flat. I was bullied almost constantly from elementary school to high school; my relationship with my mother was almost perfunctory; my sister ran away several times; my adoptive parents were divorced and my dad went missing five years later; I learned about my mother’s diagnosis; I was outed before I was ready and disowned by my mom; one of my first real relationships ended incredibly badly; I’ve been sexually molested multiple times; I lost my sister to an overdose. I’ve survived quite a lot, but it hasn’t been without significant consequences that I’m still dealing with to this day.
Despite that, I consider myself incredibly lucky. I’m in a community of wonderful, creative people who support me. I’m in a stable long-term relationship with an amazing man. I have health care that covers mental health services and makes prescriptions for medication affordable. I’m able to build an environment for myself that minimizes stress and allows me the space to find the best coping strategies that work for me.
So many family members, neighbors and friends from back home don’t have this. They’re still stuck in an environment that leaves them up to their necks in stress without the support network, mental health services, or cultural understanding they need to deal with that. Illnesses that could be resolved through therapy and lifestyle adjustments are left to progress, and they’re forced to do the best they can with little to no understanding. There’s no wonder to me that so many of my brothers and sisters turn to reckless behavior, drugs and alcohol, or even antisocial behavior to deal with everything that’s going on.
Mental health is a complicated subject that science is challenged by even under the best of circumstances. When you put the messiness of life on top of that, and the terrible sociopolitical situation we find ourselves in on top of THAT, it becomes clear that this is a big problem that will only get better if we make a concerted effort to address the things that block us from looking after ourselves. Mental illness is almost never just one thing. Sometimes it’s everything, at once, beyond our capacity to cope.
This is part of a month-long series about mental health for Mental Health Awareness Month. I’ve previously talked about my personal experience with depression, anxiety and ADHD; next week, I’d like to talk about ways those of us dealing with mental illness can help ourselves and how our friends and allies can help us in our efforts. If you’d like to know more about mental illness and what could be done to help the nearly 44 million Americans who are coping with them in any given year, visit the National Alliance on Mental Illness, the National Institute on Mental Health, and the American Foundation of Suicide Prevention. And finally, if you appreciate what I’m doing here feel free to buy me a Ko-Fi to keep writing.
One thought on “(Mental Health) My Comorbidity”
I totally agree – comorbidity is just like a cruel joke sometimes, and it’s so difficult to break the cycle of seeming to swing between different conditions which inevitably fuel each other. This was a great read, thanks!