The Free Press, Mankato, MN

Special Report: Mental Health

May 27, 2012

Suffering in Silence, Part 1: Mental illnesses set the perceived world off kilter

One Christmas, Irvin Schaefer got an iPod as a present from a cousin.

“I was totally depressed by it,” he said, his face slackening at the memory. “I didn’t deserve it at all.”

Even a chore as seemingly innocuous as mowing the lawn is fraught with anxiety. Sometimes he can only mow for a few minutes before imagining that passing cars are running surveillance on him.

As he’s sitting at the kitchen table of his St. Peter home, the notion is more than faintly ridiculous.

“Who the hell wants to watch you mow the lawn?” he asks.

It can sometimes feel to Schaefer as if he is in the grips of a force of nature that he can only watch.

“I think I’m attracted to anxiety, you know, like a magnet,” he said.

This is not to say that Schaefer is a tightly coiled mass of paranoia, a caricature of neuroticism. He’s a 62-year-old with a sense of humor who makes and sells silver jewelry. He can also talk calmly and rationally about the times when he isn’t.

Especially when untreated, mental illness can be like a distorting filter. Bound up with the lack of perspective is often a deep shame that their illness is a reflection of personal weakness.

More than 36,000 people kill themselves each year in the United States, and about 270,000 are treating for self-inflicted wounds in emergency rooms. About 6 percent of people, or about 18 million Americans, have depression. Mental illness is the most common kind of illness.

Most people with mental illness, however, Blue Earth County psychiatrist Michael Farnsworth says, “suffer in silence.”

Schaefer says it’s difficult to describe: “If you could talk to a fish, I don’t think you could explain water to them.”

He comes up with a visual metaphor to describe the emotional chaos that paranoia and anxiety breeds.

You know those connect-the-dot puzzles, where you draw lines between dots to create a picture?

For Schaefer, it can sometimes feel like he sees connections in his life that aren’t there, like a puzzle in which every dot connects to every other one.

Of course, mental illness is as impossible to explain with one case as physical illness is.

Control

Kirstin Berg of rural New Ulm says she has always been a “very driven person.”

In her early 20s, that was just a personality trait that meant she put in long hours from work and didn’t sleep much. She felt “invincible” at times, like she could do anything.

But she was losing weight, and friends said she was wound up. Those friends eventually took her to the emergency room dehydrated and somewhat malnourished.

She crashed, settling into a depression.

“I felt like life as I knew it was over,” she said. Her doctors at the time encouraged that attitude, she said.

Berg was diagnosed with bipolar disorder with rapid cycling, which means she has symptoms of both mania and depression at the same time.

About a decade later, spent six months in a state facility in Willmar. She said the lack of control for such a long time was galling.

Now, she’s feeling much better.

Berg finished training earlier this year to be a state-certified peer support specialist. She works at Horizon Homes in Mankato, helping its patients become more independent.

Her personality, even her world view, is a good fit for the job.

Berg’s attitude toward her mental illness is different from most. She does not talk about her diagnosis as if it were beyond her control. And the mere fact of this belief acts like its own treatment, like a placebo effect for the psyche.

“For me, the saying ‘mind over matter’ is true.”

For Berg, the key is to recognize when she’s slipping. Honest self-assessment rarely comes naturally to those in good health but can be especially trying during the skewed world view of the seriously mentally ill.

One of her warning signs is when she sleeps four hours or fewer every night. Racing thoughts are another sign of mania.

It’s not as simple as deciding to feel better, though, or taking medication.

“I know for some people, medication can be a switch and they’re better. That’s not the case for me,” she said.

When she has extra energy, she can turn to her bicycle or weights.

Berg is the chair of the regional management team for the Blue Earth County-led South Central Community-Based Initiative, a nine-county consortium for mental health services. She’s also on the governing board for a state-run mental health clinic in St. Peter.

Acceptance

There is a line, different with each person, between what victims can and cannot change, says Julie Soper, head of the Mankato chapter of the National Alliance on Mental Illness.

People with mental illness sometimes say, as Schaefer did earlier, that emotions come to them unbidden.

“They’re so uncontrollable,” said Heather Dumdei, a student at South Central College with bipolar disorder. “The emotions, the discomfort, like having a bad day and a great mood and you can’t control it.”

That may sound nice, but the loss of control can be scary.

“You lay on the couch and you cry because you don’t know why you’re having a good day,” she said.

Soper said she’s learned to live with people doing things, sometimes hurtful things, that are apparently beyond their control.

For her, it was her brother making strange demands.

“He won’t take the garbage out, then gets mad if you do it,” she said, as an example.

“At first, I thought, ‘You’re just being a jerk.’”

But she has come to accept the fact that she’s not allowed in the kitchen when he’s cooking.

“My brother is not the same person that he was,” she said. She has accepted it, but it’s sort of like there’s a new person to get used to, and maybe some sadness for the person you knew.

“It’s grieving, like the old person died.”

Support

It was the summer of 1980, and Julie Jones of North Mankato didn’t know what hit her.  

“All I wanted to do was sleep and cry,” she said.

At the time, Jones was a single mother raising a pre-schooler and working as a secretary in Mankato’s zoning department.

Her depression deepened, though she wouldn’t have used that word at the time.

She had a hard time explaining to her son, already confused about a recent move to Mankato, why she wasn’t there one fall for his first day of school.

That episode stole three years of her life, though the next six or so years were back to normal.

In 1989, it came back. At first, it was just leg aches and other physical symptoms. The aches, she learned, were another symptom of depression.  

It took several years to return to “normal,” but a new normal of ups and downs, good years and bad.

Two years ago, again. Lose appetite. Isolate. Sleep.

“I just couldn’t function,” she said.

She felt sort of like the actors in TV ads for depression look. Like even the slightest of tasks seems insurmountable and the joy is sucked out of formerly pleasant things.

She fought hard but eventually lost her job.

It came to this: Either she had to stop feeling depressed or die. She has attempted suicide twice.

When she talks about feeling better, Jones emphasizes family and friends visiting and sympathizing with her.

“Just having them come helped me know somebody cared,” said Jones, who lives in North Mankato.

Gregory Nelson, a Mankato Clinic psychologist, ranks support next to medications and therapy when it comes to treatment.

“I want to get a sense of their support systems,” he said of his new patients. “The quality of that support system can be the most important.”

If depressed people were fun and easy to support, though, it wouldn’t require the conscious effort that it often does.

“As a depressed person, I wanted them to leave,” Jones said. “It turns out, they were right.”

Confusion

Mental illness can be like a two-way mirror — you can see it from the outside looking in, but from the inside there’s a fog. Nobody really understood how sick Schaefer was, least of all himself, until a party in the early ’90s in Eagan with family and friends.

He doesn’t really remember the details, but his condition had deteriorated to the point where his family drove him directly to the hospital after the gathering.

Longtime friend Dan Nickel said, “Especially once they got him out of his home environment, they realized how bad he was. They realized he needed to go to a hospital.”

Looking back, Schaefer knows they were right.

“I was isolating. Not coming in contact with anybody who could take a look at me.”

Even Schaefer, living with his mother at the time, could tell his life wasn’t in the best of shape. But his world view at the time

didn’t leave much space for self-reflection.

“The thing I do remember was that everything was other peoples’ fault,” he said.

Years later, the family members who took him to the hospital thought Schaefer must resent their intervention in his life. He does not.

“You saved me,” he remembers telling them.

Of course, taking therapy and drugs aren’t a cure for mental illness, only a treatment.

Nickel said he remembers being upset when Schaefer left the hospital for the first time. His friend was much improved, but there was no follow-up beyond some instructions. It didn’t work for long.

“I just remember either his mother explained it or they just explained it to him, and he never followed through with anything,” he said.

This would be fine for a physical illness, but expecting a seriously mentally ill person to take charge of their treatment is backward; if they had the perspective to treat themselves, they would not have needed a hospital.

Schaefer ended up back at the hospital but was released early while he “wasn’t in any condition to be sent home.”

Many years later, Nickel is still helping out with odds and ends, like setting up a contractor to work on the roof or painting part of the house.

But as the previous anecdotes demonstrated, recovery from mental illness is relative. Schaefer, for example, says he will probably never be entirely rid of it but is confident he’ll never be as bad as he was in the beginning.

And just as Kirstin Berg uses clues like sleeplessness to cue her in on developing problems, there are some thoughts that act as their own warning. In Schaefer’s case, one example is Pat Anderson, who checks in on him weekly as part of the Community Support Program.

“When I think Pat is evil, I’m sort of aware that things aren’t good.”

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Special Report: Mental Health