(Trigger Warning: This post covers a lot of things that I think could be potentially triggering, though none of them graphically. I can’t really delineate anything here, because there is nothing especially specific to warn you of. I’m not entirely sure this is even necessary. But I will err on the side of caution.)
We don’t ever talk about it, we don’t ever even want to think about it, but lately I have had to spend a lot of time and energy focused on a terrible reality, and I feel it needs to be discussed. In this wonderful online community that exists as a support network for those who deal with severe trauma and mental illness, where nothing is judged as taboo, where everything can be talked about, one thing never is. It is the ultimate boogeyman.
The idea of permanent non-recovery.
I don’t mean something so stark as depression that ultimately leads a person to suicide. Nor do I make reference to individuals who are “non-compliant,” who consequently cannot effectively utilize medication, therapy, treatment, etc. to improve their psychiatric and psychological states.
What I am talking about is every bit as heartbreaking as suicide, and in the particular instance I have been dealing with does involve something that some would call periods, or perhaps episodes, of non-compliance. But I will tell you, lovelies, they would be completely incorrect to make that assessment.
I have a friend, I will call her Ophelia, both to provide complete and total anonymity, and because it seems the only name befitting someone so beautiful and undeniably tragic. I have known Ophelia for about two decades, and while we drifted from time to time, we have always had an intimate, honest, preternatural bond.
Ophelia has struggled with many things in her life. She is diagnosed with Bipolar Disorder (type I), Borderline Personality Disorder, and Post-Traumatic Stress Disorder. Ophelia is an alcoholic in recovery, an addict in recovery, and was hospitalized numerous times in her teenage and young adult life for anorexia and bulimia. I also witnessed her go through a very serious bout of postpartum psychosis.
She has attempted suicide at least a half-dozen times. These attempts were all serious enough to warrant 911 calls, ambulance rides, and hospitalizations, but knowing her as I do, I would say that they would be most rightly classified as parasuicidal. Death is not her intention, rather she becomes so distraught that she feels the only way she can communicate the full depth of her torment and truly express how desperately she wants help to become well is to take the ultimate gamble. As I said, this is my assessment, she has never told me as much. I don’t believe for a second that she even is consciously thinking about anything but ending her life. But I know that my evaluation is correct.
So Ophelia has a deck that is just about as stacked against her as it could possibly be. Oh, I forgot to mention that she also has a number of somatic conditions that would make her life incredibly difficult even in the absence of mental illnesses. Combined with them, it is truly a wonder that she is still alive today.
That is Ophelia the patient. Ophelia the woman is vibrant, loving, intelligent, educated, compassionate, loyal, articulate, beautiful, and wickedly funny. She has a family, a husband and small children, she had for many years a very successful career, she advocates for the things that afflict her. She was raised in a relatively stable and loving home, her parents try to be supportive of their daughter, her husband loves her and is learning – or trying his level best – what he can do to help her as much as anyone is able. Her little ones absolutely adore her, and they should, because in spite of that stacked deck, she is an amazing mother, absolutely devoted and determined that her kids will not be negatively impacted by all of the things she deals with.
She takes her medications compliantly, for the most part, and she has been through years of intensive therapies, both inpatient and outpatient, to try to get to a place where she can find her footing and live her life. And for a while, she could.
But not within the past few years.
Ophelia started to decline about two years ago. At the time it was easy enough to explain. She was pregnant with her second child, she was over-extended in her work, she had a ton of other life stressors that were triggering her. And as these last two years passed, there was always some way to rationalize why she couldn’t remain stable. This girl has had an enormous number of very serious life events, one right after another, sometimes concurrent or overlapping, one into another. There has never been a chance for her to truly stabilize.
So I told myself, for a long time, and up until the end of last year it may have been true. But the past six months or so, things have been very different for Ophelia, and I have been forced to reevaluate her condition and face some realities that are. . . heartbreaking, painful, distressing. . . Those words don’t even come close.
She has reached a place of very serious cognitive decline. She is still so breathtakingly intelligent, but she can’t apply it, can’t use it for anything but ill, because her ability to research and understand has turned on her. She forms obsessions, about herself, about others, and about the world at large. She is often quite confused about reality, and will leave me messages that make little or no sense. She becomes fully delusional. Her periods of depression and mania have become drastically more intense and frequent. She has episodes of abuse of prescription and non-prescription drugs (I feel I must stress to you that she still manages somehow never to put her children at risk).
Her periods of stability have become fewer, shorter, and much more tenuous. And even though she sees her doctors regularly and goes to support groups and therapy, I really don’t know how useful all of that could possibly be. Because the most frightening part, to me, is that she has no concept whatsoever of how profoundly ill and diminished she is. I honestly don’t think anyone does, other than me. What I see is a product of all of our years, the complete transparency of our relationship, and my own personal knowledge of living with mental illness.
I honestly do not believe that Ophelia will ever recover. And that was an extremely difficult place for me to come to. I don’t know what her path will be. I am terrified that she may eventually get one of her parasuicidal attempts wrong, that is to say succeed in taking her own life without meaning to. I have already detached myself to some extent, because I know I cannot save her, and it was destroying me to deal with her unrelenting outcries for help. She may not understand the depth of her madness, but somewhere inside she feels herself drowning, and she is grabbing on to the most stable and constant person in her life. And I will stay with her forever, come hell or high water. I have drawn my own lines, because I have come to understand that I can only do so much to help her, but I will never let her go, no matter what is to come.
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