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Imagine you’re a young professional attending an interesting lecture. You hear the speaker’s words, but inside your head you also hear something else. It’s like a tape that plays messages over and over or repeats a command—“Read this book” or “Wash behind your ears.” You have difficulty concentrating. You manage to hold it together during the week at work, but on weekends you keep to yourself.
This was Betty.
Now imagine you’re a tense young mother. You’re starving yourself, eating little more than rice and fruit because you believe anything else will make you sick. One evening while bathing your ten-month-old daughter, you step back from the tub and say to yourself, I really don’t care about her. Your husband shows up and you think, I don’t care about him either. You set out on a walk to regroup but start thinking about jumping in front of a car. Instead you go home and ask your husband to take you to the emergency room.
This was Meredith.
Although they’ve never met, Betty and Meredith have a lot in common. Both are smart, accomplished, and well spoken. To most observers, the women seem to lead normal lives. Betty, 39, is an editor. She loves to travel, spend time with friends, and take her dog to the park. Meredith, 38, is a partner in a design firm. She’s a devoted wife and mother of two. Both women live and work in Washington but have asked that their real names not be published. That’s because Meredith and Betty are battling mental illness.
A Long Journey
About one in four American adults suffers from mental illness each year, according to the National Institute of Mental Health. And while some people, like Meredith and Betty, manage to work as they search for help, the journey to well-being almost always exacts a price in terms of relationships, physical and emotional health, income, and time.
It takes an average of eight years for someone to seek treatment for a mental disorder. “The reasons for this include stigma and access to care,” says Mayada Akil, director of the Mood and Anxiety Disorders Program at Georgetown University Hospital and an adviser to the director at the National Institute of Mental Health. “It’s an alarming statistic because you know the disorder is affecting all aspects of their lives.”
Betty suspected something was wrong as early as elementary school but didn’t consider asking for help until college: “I was a psychology major, and I remember taking a course where they gave a checklist for depression. I answered yes to every single question.” Soon after, Betty made an appointment with a university therapist: “When I said out loud that it was as though words were playing over and over inside my head, she said, ‘Of course.’ I felt safe for the first time in my life.”
Both Betty and Meredith have spent years bouncing from doctor to doctor, sampling medicines and therapies, and experiencing setbacks. “I feel like there are pieces of my life that are just a fog,” says Betty, who spent more than a decade seeking an effective treatment. “It’s lost time.”
During the past year, though, each has settled on a treatment that is proving effective—Betty for depression and obsessive-compulsive disorder, Meredith for bipolar disorder. Both women are doing well and, with the help of psychiatrists and therapists, learning to manage their conditions.
What to Watch For
The most common mental illnesses are mood and anxiety disorders. Mood disorders include major depressive disorder; dysthymic disorder, a mild but chronic depression; and bipolar disorder, also known as manic depression. Anxiety disorders include panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and phobias.
Knowing the signs of mood and anxiety disorders can help. For depression—which affects nearly 15 million American adults a year—symptoms can include trouble sleeping or excessive sleeping; a change in appetite; fatigue; feelings of worthlessness and guilt; extreme difficulty concentrating; agitation, restlessness, or irritability; withdrawal and a lack of interest in activities that were once enjoyable; feelings of hopelessness; and thoughts of death or suicide. Major depression is diagnosed when someone experiences five or more depressive symptoms for at least two weeks.
The same symptoms play a part in bipolar disorder, which causes mood swings that alternate between severe depression at one extreme and mania at the other. The manic phase is characterized by euphoria, inflated self-esteem, poor judgment, rapid speech, racing thoughts, decreased need for sleep, and inability to concentrate.
“You have this bloated sense of self when you’re manic,” says Meredith, who has experienced three bouts of bipolar disorder. In her case, depression and mania either alternate or occur simultaneously. Experts refer to the latter scenario as “mixed state.” Meredith calls it “the worst thing you can imagine.”
“The world makes no sense,” she says. “When you’re manic, there are not enough days to live. When you’re depressed, there are too many. When you put those two things together, it’s a disaster. It’s as though someone has cut off your leg or you have burn pain and can’t get medication—only it’s all in your head.”
Many mood and anxiety disorders occur in pairs. People with depression, for instance, can be diagnosed with panic disorder; generalized anxiety disorder, a condition in which people experience exaggerated worry; or obsessive-compulsive disorder. A person with OCD experiences unreasonable thoughts or fears (obsessions) that can lead to repetitive behaviors (compulsions). Someone who fears being contaminated by germs or dirt might be driven to wash his hands until they become chapped.
“People in these situations—with anxiety and depression—are often very uncomfortable,” Akil says. “All common sense is gone.”