“Whoa, whoa, I can’t, I just can’t,” the early thirties man said, doing a cutting motion across his neck with his hand. We were sitting in a group of about ten, performing the usual round-robin of sharing our trials and tribulations of the week. The momentum, as it tends to do, came to a stall: a woman got on a roll speaking about her problems and did not stop.
She spoke for a clear ten minutes before people shifted in their seats and looked at one another, hoping someone would stop the claustrophobic experience of being held verbally hostage. Fifteen minutes in, the man, appearing more and more uncomfortable by the minute, boiled over in anxiety and spoke over the woman to the volunteer hosting the group: “I just can’t.” We were all at our wit’s end and thankful he spoke up.
Mental “illness” is lonely. No matter the diagnosis, we feel isolated, which is why treatments involving human interaction are often recommended. Even readily used concepts, such as I just used with the words illness and diagnosis, are hazily defined and thus problematic. I explored various therapy groups for years, from informal ones on meetup.com to hospital-sanctioned ones. No matter who ran the group, it always turned into a giant mess by the end. I am not sure if I have ever had what I would call a “good” group experience.
It is, in a sense, glaringly obvious. If you put anywhere from five to twenty mortally desperate people in a room together, what do you expect? Emotions will spill over and people will jostle for time and topic. In my groups, even the most kindhearted had attempted to either become the center of attention or slink away into silence, often leaving early with a silent nod or a whispered “sorry” and a quick shuffle out of the room. They had attended, after all, to find a balm for their psychic wounds — not to become the audience for someone else’s therapy.
Therein lies the problem with group therapy, and in a wider sense the problem of the mentally distressed banding together to attain a sense of camaraderie: the focus is on discussing something that is just too deep, complex, chronic, and painful. Sufferers need a space to air their emotions and find connection, but we are talking about depression or schizophrenia, not basketball or finances. A weekly meet-up is a framework that does not handle this discussion very well.
I think about my close friends who suffer as I do, and how we connect with each other, how we leave the conversation feeling better off. A large factor, I think, is that we barely speak about our pain at all. We simply know that we suffer, and the knowledge that we are going through a similar struggle flows out into how we interact. If I say to one of these friends, “I’m sorry, I don’t want to do that, I just want to go home,” he does not ask why, or wonder out loud if I am okay, or chastise me for not having as much energy as himself. He just says “okay, sure,” or perhaps suggests something calming, like sitting silently at a cafe as we sip our drinks and listen to the sounds of the city.
In the end, the therapeutic effect we get from human connection may be less about discussing our problems outright and more about matching wavelengths with someone, so to speak. One could argue that this is what it means to not be lonely. It’s feeling that how we view the world is justified, or accepted by others. With group therapy, even though I was in places bursting with people suffering the same fate as myself, I never felt as though anyone’s wavelengths were matched as we sat in chairs, in a circle, waiting our turns like fourth graders, in a room that I found was often unpleasant and poorly lit.
It seems cumbersome to create a group for the mentally distressed centered around an activity — lest we exclude anyone who dislikes ping pong, or bird watching, or sci-fi movies — but I wonder how well that would work. In a group therapy circle, the pressure is on to perform; it is a stage of a terrible kind. The high-pressure environment encourages everyone to judge your story and compare it to their own, like an open mic night for mental illness. But if you are, say, a severely depressed person birdwatching in a park with a group, what conversations, both verbal and nonverbal, would come about? What kind of camaraderie would be felt? Would wavelengths be matched, would you feel less alone?
The suggestion reminds me of the now famous Rat Park experiment. The Canadian psychologist Bruce Alexander, while studying drug addiction in the late ’70s, built a giant cage for a community of rats, filled with balls and running wheels, and gave them two bottles of liquid to drink: one of water, and one of morphine. He compared this to rats living alone in cages with the same choice of liquids. The solitary rats fell into a deep morphine habit, while the citizens of Rat Park chose to drink water. Some of the solitary rats were moved into Rat Park to test dependence; they quickly moved away from the morphine solution and drank water.
The difference, of course, was the community. There were other rats and things to do. I doubt that the new citizens of Rat Park created a therapy group for morphine users and discussed the constant craving for another hit. No, they simply had a place to belong. After dealing with my severe depression and anxiety for over a decade it has become my tacit belief that, after a couple years or so have gone by and we have succeeded in understanding the m.o. of our suffering, a great deal of the pain comes from the isolation others force upon us because of it. Even though we are not caged physically like the rats, we are caged psychically.
An interesting book called Loneliness by John Cacioppo details just how dangerous chronic loneliness can be. Roughly speaking, chronic loneliness puts us into a 24/7 fight-or-flight mode, which moves massive amounts of energy away from repairing our bodies and into vigilance for danger; over time, our bodies do not get the repairs they need and deteriorate. The chronically lonely have a twenty percent chance of an early death, all the while suffering the crushing sadness of loneliness. And of course the lonelier you are the less appealing you are to others, continuing the downward spiral of isolation.
If we add the social effects of mental health distress together — chronic loneliness, career difficulty and instability, unstable friendships, difficulty telling friends and loved ones how you actually feel for fear of misunderstandings, a culture not designed with your mode of being in mind, et cetera — we see that these social effects can easily be much more of a problem than the mental distress itself. This is what we try to combat with our inadequate idea of group therapy.
I did, I must confess, have one moment of camaraderie in group — well, right afterward. I was walking out of the hospital with an older man, and I posed a question. Where does most of the pain come from: our mental health struggle, or a world that is not set up for us? He did not hesitate. “Oh, about 80 percent of it comes from the world, I’d say.”
Ask yourself, how much of the pain is in me, and how much is outside coming in? I was surprised by the answer when I asked myself, and surprised when the older man gave the same answer. I would not press a button to magically get rid of my issues, and anyone I have asked that question to says the same (Stephen Fry made the same point in an interview about his bipolar diagnosis).
I have found that my mental health issues become, at times, pleasurable. The abyss of depression, for example, is a fantastic place to feel just how weighty existence truly is, and what that means. It provides a meditative quality that can be existentially peaceful. This is extraordinarily difficult to achieve normally, and yet if I do things right, I can experience this profundity every day. This is, of course, not to say that the mentally distressed are actually just regular people who are “misunderstood,” or that living with mental health issues is not a terrifying, powerfully damaging existence, only that the full story is complex. Another example: Borderline personality disorder causes my friend great suffering, yet if she hears a song she loves, anyone can tell that she feels the meaning of the song with an unmatched clarity. Even in our dark worlds there is numinous beauty, but if I tell someone who is neurotypical that “sometimes I enjoy depression,” that will not go over too well.
So much of our suffering is simply being lonely, wavelengths left unmatched. I often feel like I am in a foreign country. I do not seem to speak the same language as neurotypicals, their work schedules seem strange, and their cultural practices seem bizarre. If I imagine being forced to live my whole life in a foreign country that views me as, at best, someone to be pitied unless I learn their language, adopt their culture, and admit that my previous language and culture were objectively inferior, it is simple to see why I and the mentally distressed struggle to survive.
The neurotypical and the mentally distressed, if I may chance such a bold statement, have separate umwelts: an ethological term for the way an animal experiences the world (e.g., what it is like to be a bat; how someone views and feels about reality). Forced to live in this foreign country, this foreign umwelt, I am angry. Furious. Yet, what can I do? What can we all do as, perhaps you could say, “a people,” or a tribe? Should we not view ourselves that way?
Group therapy does try to solve this issue, but we need something better. What we truly need is for society at large to rework its idea of mental health issues — but until then, it would serve us well to create a better bastion for our weary souls. If not, we will continue to be a lonely lightwave in the dark, our shine swallowed by the vast emptiness that surrounds us.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.