I hate the term “relapsing.” In the context of recovery from mental illness, it implies that healing is a linear process, and to relapse is to regress or backslide. People who live with mental illnesses know that symptoms and unhealthy coping mechanisms can burst through our functioning, particularly during times of great stress, even with meaningful healthcare and support. Unfortunately, there’s no clearer term to describe what I’ve been experiencing lately—an onset of symptoms associated with my PTSD, and an inability to manage some of my more damaging BPD behaviours.
Like many of my low periods, it wasn’t just one thing that led to my dip in functioning. It was a convergence of numerous factors that resulted in my recent relapse.
My Ukrainian Baba has been dead for five years, but since the Ukrainian-Russian war started, I see her in every bowed and kerchiefed woman determined to make it to the Polish border on their two wrinkled feet. I’ve grappled with the notion of do I even have a right to my diasporic grief? I was born across the Atlantic. I haven’t played in the Dnipro, hiked the Carpathians, nor can I catch a baby bird in my hands mid-flight, like my Baba could. But, to see people who share my cheekbones and ample calf muscles dead in the streets, shot in their heads with their hands tied behind their backs, to read the stories of sexual violence perpetrated against women who look like my female family members, provokes an inherited physical sorrow that my family has been trying to run from since they left Ukraine. Life’s daily activities became hopelessly mundane. It felt silly to bang what seemed like inconsequential words into my keyboard, sweep the floor each morning, and scoop the cats’ poops.
And then, a shock of domestic bullshit layered on top. Six weeks after moving into our new apartment, I noticed a stranger looking through our ground-floor window, only accessible by walking a good way down a private driveway. A day later, we received a call from our landlord. Our neighbours complained that we were smoking weed in our apartment—we weren’t. We told them as much when they approached us the next day, and even agreed to take any future weed smoking off the property (we have an ample backyard) in an attempt to be friendly and considerate. But, I once again awoke to our neighbours’ eyeballs looking through our window. We received letters about how it was inappropriate for me to ask them to stop trespassing, how they were going to try to hold us liable for their medications, and how they were going to kill themselves. Eventually, we had to file a police report. A few days later, they admitted the weed smell wasn’t coming from us, apologized, and wondered if we would help them find the source. We declined.
In the meantime, my stress skyrocketed. I’ve been stalked before, and the invasion of privacy threw me into my fight or flight instinct. I had full-symptom panic attacks, couldn’t sleep despite my medication, failed to keep my self-harm in check, and only felt comfortable in our space when my partner was also in it. But, there were signs I was headed for relapse even earlier: between moving apartments and more professional opportunities, I was spending very little time taking care of myself. All of my waking hours were filled with work or packing and unpacking. My thoughts took a destructive turn, my internal monologue went from biting to disparaging, and I was isolating myself from my support networks in the name of busyness. Had I been more mindful and noticed these changes earlier in my decline, I might have prevented it from becoming so steep.
Common relapse triggers
I was just a little too smug heading into our move. I genuinely enjoy organizing, sorting, and packing, so I didn’t believe it could put a strain on my mental health. My partner and I lived in the same apartment for several years, but I’ve moved so often in the past that I considered myself immune to the anxiety associated with it. I figured the most intense aspect of moving—finding an affordable apartment in Toronto—was behind me.
Moving is said to be one of the most stressful experiences in life, and stress is one of the more common causes of mental health relapses, in addition to medication or hormonal changes, or substance use. People with mental illness can also suffer relapses from relationship issues like break-ups or loss or from setting or having others set unrealistic expectations of them.
My relapse was prompted by unrealistic expectations around the emotional toll moving takes, and not flagging the experience as a potential trigger for relapse. If I had, I might have been more mindful of the early warning signs that presented themselves.
Identifying early warning signs
I kept finding reasons to ignore the warning signs of my deteriorating mental health: my lack of appetite was a positive thing because I had gained weight over the winter; my interrupted sleep—despite being medicated into slumber each night—was probably a result of going to bed in a different place; my slipping hygiene was simply a matter of free time; and my problems with concentration had been growing since the start of the pandemic.
Early warning signs of relapse include changes in sleep patterns and appetite, isolating from others, feelings of loneliness, irritability, difficulty concentrating or forgetfulness, inability to relax, poor personal hygiene, and/or unexplained aches and pains. Other warning signs could include—depending on diagnosis—an increase in risk-taking behaviours, delusions, paranoia, or confusion.
This wasn’t my first relapse, yet I spent weeks in denial that it was happening. If I accepted the early warnings signs for what they were, I probably wouldn’t have ended up in crisis.
Creating a plan for emergencies
“Please, please make it stop,” I cried to my partner, on the verge of my fourth panic attack that day. “I can’t have another one.”
“Should I call 911?” he asked.
A swell of fear overcame me. Police in this city don’t have a history of successfully de-escalating mental health crisis calls, and I was in rough shape that day. My face and neck were covered in self-inflicted scratch marks and my brain was reeling from being high on Ativan. I was afraid the police would hurt me instead of help me. My breath left my lungs and I gagged on the lack of the air. “Please don’t call the police on me,” I said between heaves.
The police didn’t come, and I white-knuckled it through the rest of the day, but the experience wasn’t just excruciating for me, it was daunting for my partner. Neither of us was certain of the best route to take during my crisis. I was aware of Toronto’s Community Crisis Support Service pilot, a community-led solution to mental health crisis calls, but wasn’t able to communicate it as a potential resource when I was spiralling, nor did I have the ability to research if it even covers our neighbourhood.
That day showed us we needed to develop a plan for my mental health emergencies that didn’t involve police or sacrificing my personal freedom. My therapist suggested that the three of us have a joint session, where we could develop an easy-to-follow crisis plan to ensure we knew what to do during one of my infrequent meltdowns.
Returning to self-care
To me, the term “self-care” is as watered down as “trigger” or “trauma.” Self-care has come to mean mundane activities like taking a bath, eating a nice meal, or going for a walk (things we should be doing regularly anyway). And honestly, I’ve taken so many goddamn baths and stupid mental health walks over the pandemic that at this point the returns have really diminished. There’s also a tendency to refer to self-care as the antidote to burnout, when in reality it should be consistently incorporated into daily routines for prevention, not treatment.
My therapist recently reminded me that self-care isn’t just physical lifestyle choices. It’s about engaging in activities that help me feel mentally and spiritually rejuvenated. When I was struggling with a sense of guilt about taking a sunny afternoon to vent to a close friend about the invisibility of women’s domestic labour, my therapist reminded me that a good bitch session during a pleasant afternoon can be self-care. Self-care is also setting boundaries to reduce stressful events. My partner and I were expected to be at both of our families’ homes (who live in western and eastern Ontario, respectively) for Easter Sunday. It would have meant about six hours of driving in a single day for a few hours of rushed and chaotic visits. I told my partner I was too overwhelmed to do it this year. We decided to visit his family on Saturday instead, which will allow for a more relaxing holiday.
It can be hard to take a step back in a society where we’re conditioned with the idea we’re only as valuable as our professional output or levels of productivity. But, a car can’t function with no gasoline in the tank, and people can be their healthiest selves when they’re running on fumes.
Mad History
This issue: Medically assisted dying (MAiD) for people with mental illness
“History” is a bit of a misnomer for this issue of Life as a Lunatic— “Mad Future” is more accurate. In March 2023, Canada will grant people with depression, personality disorders, PTSD, bipolar disorder, or schizophrenia the right to die with medical aid. This means, in less than a year from now, I can request to die with the help of a doctor if my symptoms produce too much suffering.
Framed as a form of compassionate care, I worry this development will replace efforts to create equitable access to mental health support, find meaningful treatment strategies for poorly-understand mental health conditions, like personality disorders, and will further entrench the notion that certain mental health conditions are untreatable, despite evidence to the contrary. Proponents of MAiD for people with mental illness have stressed that the assessment process will be rigorous, and already has safeguards in place. But, this February, a 51-year-old Ontario woman became the first person to be granted MAiD for multiple chemical sensitivities (MCS), a chronic environmental illness, after her search for affordable housing free from cigarette smoke failed. “The government sees me as expendable trash, a complainer, useless, and a pain in the ass,” the woman said in a video filmed before her death that was shared with CTV. Though I don’t want to take anything away from people with disabilities seeking MAiD who are suffering as it is a personal choice, people who are experiencing poverty, inequality, and are falling through gaps in current legislation shouldn’t see death as their only option.
By offering medically assisted dying to people with mental illness instead of creating a society that is accessible for people with a range of disabilities, the message is clear: if social and health care interventions fail a person, perhaps they’re better off dead.
Recommended Reading
Lived Magazine, Vol. 1
Edited by: Camille Alizadeh
Lived Collective is a community for people with lived experiences of madness and neurodivergence. The collective, created by my fellow Yale Fellow Camille Alizadeh, publishes Lived Magazine, a platform for people with lived experience to share their perspectives and passions, and dispel stigma by redefining what mental health means. The inaugural issue is stunning, and features poetry, fiction, nonfiction, photography, and artwork from the mad community (including a piece by yours truly).