The Invisible Illness

Eileen Merriman

I’ve often wondered what speciality I’d have chosen, if not haematology. Somehow, I keep looping back to psychiatry, which is odd, as I certainly wasn’t drawn to the discipline as a medical student. And yet, fascinated by the combination of art and science, I’d earned A+s and As in my psychology papers in first-year university. It’s increasingly clear that the mind and body are inextricably entwined, in sickness and in health, ‘til death do us part. Perhaps, at the time, psychiatry was far too close to home, with too many reminders of my own family’s mental health history – schizophrenia, obsessive compulsive disorder, anxiety and a depression so severe that it ended my brother’s life at 21.

Here are some facts about mental illness:

1. When thrown into fire, lithium flares bright crimson. It is also the most effective known treatment for manic depression.
2. The best way to stop a conversation is to announce that your brother committed suicide. There is no good response for this, so most of the time you will not offer the information.
3. The solitary confinement of one’s mind is far more deadly than any poison I know of.

‘Stop waiting for the old me to come back,’ my brother told me a year or so before he died. ‘This is me.’ But I didn’t, couldn’t, believe it. Where was the witty, super intelligent brother who built his own computer at the age of 15; who, at three years younger than me, was my best friend? Gone, sucked into a vortex of anxiety and black moods. I never got my brother back. It was 20 years before I could talk about his death. Then, three years ago – another suicide – my mother. The faultlines run deep in my family. It’s in our DNA. But I refuse to believe that it cannot be changed.

It’s very easy to tell people that all they need to do is take their medication when it makes them put on weight, makes them so sedated they get through the day with triple and quadruple shot coffees and, in my brother’s case, gave him terrible acne and red skin during his most self-conscious years as a teen. The same medication that prevents the psychotic symptoms or treats the anxiety and depression may inhibit creativity. ‘I feel less anxious but I can’t write like I used to,’ one friend told me. It’s the price she pays for mental stability. Too high, some would say. I don’t blame them. We need better treatments. We need better research. But mental health isn’t sexy. There are no Give-A-Little pages for severe depression or bipolar disorder. Suicides rates for the latter are 10 to 15 per cent. Just saying.

Treatment of psychiatric disorders may not attract the same attention or funding as, for instance, breast cancer, but they are more prevalent and just as deadly. Recently, I was shocked to learn that 90 per cent of New Zealand’s prison population had been diagnosed with a psychiatric or substance abuse disorder at some point. Thousands of lost souls, incarcerated. Yes, some of them have committed dreadful crimes, grievous bodily harm, but delve into their backgrounds and the common themes emerge – family violence, sexual abuse, poverty, unaddressed learning disabilities, to name a few. We don’t want to know. We look away. But look again. New Zealand has some of the highest youth suicide rates in the developed world. These are our people, our children.

More broadly, a 2023 Harvard study showed that, worldwide, one in two people will experience a mental illness by the age of 75. I may be a haematologist, a blood specialist, but an understanding of the impact of mental health on physical illness is core to my practice. As a doctor who treats cancer, I am fully aware that patients with depression and chronic distress have higher cancer mortality rates, but until I researched this further, didn’t realise that these death rates were up to 80 per cent higher.

It took a Covid pandemic for me to realise that humans truly are social animals, even the introverts. Small wonder that, in years gone by, those cast out from their communities were doomed to die an early death even if all of their physical needs were met. Even in modern day times, social isolation is a risk factor for dementia and early death. We need each other –to listen, to understand, to reflect, to soothe.

‘Am I crazy?’ This was the question recently posed to me by a patient with chronic pain after their deep vein thrombosis, a clot in their leg. An ultrasound showed the clot had gone, but the pain remained. ‘Of course not,’ I told him. ‘Just because we can’t see what’s causing the pain doesn’t mean it’s not there.’ That didn’t mean it was easy to treat, of course. When abnormal pain pathways persist long after the injury, the danger, has gone, it is distressing and frustrating. Patients often feel ignored, unheard. Often all I can do, apart from prescribe pain medications that are only partly effective, is listen. One patient sees me once a month solely for that reason – to have someone listen, to have someone understand. Her illness is invisible. Her pain is not.

Where to get help. Need to talk?

Free call or text 1737 any time for support from a trained counsellor.

Lifeline: 0800 543 354 (0800 LIFELINE)

Youthline: 0800 376 633, free text 234, or email talk@youthline.co.nz

Samaritans: 0800 726 666

Aoake te Rā – 0800 000 053 — Free counselling for people bereaved by suicide, weekdays 8.30 – 5pm Mental Health Foundation

Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO) — If you, or someone you know, may be thinking about suicide, call for support from a trained counsellor

In an emergency, call 111.

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Eileen Merriman is is an award-winning New Zealand author of 14 novels for teen and adult audiences. She is clinical director of haematology at North Shore Hospital. Read Eileen’s bio on Penguin here.