My mental health has been rotten lately. The thing about depression and PMDD (and, I imagine, a lot of other mental health disorders) is that they tell you that you are alone, and then they make it happen.

Imagine, if you will, that you have bombs going off in your brain. (Matt Haig in his bestselling Reasons To Live describes depression as walking around with your brain on fire, so that works too, but I’m going to run with the bomb metaphor.) You can be in the grocery store or chilling in front of the television or walking the dog, and bam they start– the explosions in your head. And they don’t kill you. In fact, to all appearances, there’s nothing wrong with you. Nobody can tell by looking at you that anything’s wrong. Yet here you are with bombs going off in your brain, and it’s invisible. There’s no rhyme or reason to it. Sometimes it’s just a smoke bomb every now and then. Sometimes it’s a blitzkrieg. And sometimes it’s a nuclear explosion. When there’s one of those, it’s unbearable. All you want is for it to end. You can’t think, you can’t see a way out. You’re trapped in the midst of the massive shockwave and radiation, and you can’t die. You want to die. You wish that it would kill you, not because you want to be dead, but because it seems the only way to escape the meltdown in your brain.

            And then, let’s say it does end after a time. You’re walking around with mental shell-shock, feeling like a ghost of a person, but to everyone around you you’re still flesh and blood. The worst part is, you don’t know when the bombs will return. You don’t know how bad they will be when they do. Even when your brain is feeling relatively normal, you can’t ever forget the threat of the bombs.

So that’s the first way that mental illness makes us alone– because it is invisible. I’m not missing a limb, I’m not emaciated or visibly ill or disabled– I can walk and speak and generally pass as a completely healthy person, and only someone close with me would be able to catch a hint of what’s going on in my brain. Because I can wear the “normal”  mask, people expect me to function normally. I am alone in the private hell my brain has made for me, and no one will know unless I tell them.

            The second way that mental illness isolates is because of the innate human horror of madness.

            Think about it. In ancient times, the mentally ill were labeled demon possessed, and driven from the tribe or the village. In more recent human history we were locked up in asylums and treated with unspeakable cruelty. Now we have psych wards and isolation wards and institutions– politer and more humane ways of isolating us, but it’s still isolation. We know the drill– quarantine yourself when your brain is acting up, or somebody else will do it for you. Madness is only socially acceptable from a distance.

The one time I went to the emergency room because of my mental health, they put me in a separate waiting area until they took me to triage. And once there, in the face of every person who came in to talk to me, I could read the discomfort. I could feel the way they emotionally were distancing themselves from me– since they couldn’t physically distance themselves. I was a human in pain but I was treated as a problem to be solved, and once they had satisfied themselves that I wasn’t going to kill myself, they sent me home. They wanted assurance that my existence would continue, but it didn’t matter to them what that existence would be like, as long as I didn’t end it.

I learned my lesson: if I cease to be able to present myself as normal, then I physically sequester myself. I stay home. I’ll retreat to a locked room, if necessary. The only one who might bear witness to the outward effects of my brain’s nuclear meltdown is my husband. Nobody else wants to see that. Even my husband had to learn how to push past the desire to look away. And I am careful never to communicate anything that might lead someone to believe that my voluntary isolation should become involuntary. It is better to be alone in the dungeon than to be there with people who will look at me through bars and make me promise I won’t kill myself, because if I do there will be a lot of paperwork and that would be inconvenient.

But even though most of the time I can superficially present as a normal person, it doesn’t mean I can function that way. And the long-term wear and tear of mental illness extends into all facets of life, and in none so much as in relationships.

Many times I have wished that I had cancer instead of mental health problems. Not only is cancer understandable in our society, you have the added benefit of knowing that either you’re going to die or you’ll get better. I know that sounds coarse, but it’s true, isn’t it? The suffering will have a termination in one way or another. And all the people in your life know that. They’re happy to re-arrange their schedules for you, to step up and help out, to be there for you when the pain is really bad.

But when the disease is not only invisible, but it’s going to last the rest of your life? When it’s unpredictable? When you can’t make commitments because you don’t know if just getting out of bed that day is going to be all you can manage? When just continuing to exist takes up all your energy and you have none to spare for anything extra?

Relationships suffer, or fade. And there’s no blame– after all, good relationships require give and take. Community is built of individuals giving of themselves. When I am empty, I have nothing to give. The text goes unanswered, the get-together never gets scheduled, and I feel the weight of who my brain makes me to be, squeezing those lifelines thinner and thinner. You are alone, says the disease in my brain, and it is like swimming against a riptide to disregard that message and communicate my pain. And when there is no response, or when the response is short or pat or trite, and I come falling back exhausted into the depths, we told you so says the disease. And it is right. I am alone. Next time I won’t try to communicate, because it hurts less than trying and getting an emotional pat on the head.

There are a few relationships that don’t fade, the people who stick it out, and I feel ashamed of my endless neediness. I try to ration myself out. I live in fear of the day when even those faithful few finally get tired of my unending issues, of the fact that my brain refuses to get well and stay well, and they’ll fade, too. And I won’t be able to blame them.

If you are lucky, you can pay for a therapist. For an hour or two a week, you can pay to be not alone. You can purchase someone’s listening presence, where you don’t have to present as normal, where you can appear as much a wreck as you feel. It’s the irony of mental health in a capitalistic society. I’m grateful for therapy, it’s certainly saved my life more than once, but there are some parallels, I think, between paying for therapy and paying for a prostitute. In both instances you’re paying for a relationship that for whatever reason you can’t get organically.

Some people say we are never alone, that God is always with us. And that sounds really nice, and I want to believe it, I really do. But if that Divine presence does jack-shit to help me feel better, then what good is it? If there’s a nuclear explosion going on in my brain, I need someone who can either drag me out of it, or else be with me and convince me that it’s not going to last forever and it’s worth staying alive. I would like to hear God’s voice or have an overpowering sense of supernatural peace come over me in the middle of one of those explosions, but it hasn’t happened. And maybe some people would say it’s my own fault, because I’m not trying to hear God or if I don’t believe God’s there I won’t feel him/her/them. And maybe it is my fault. But when my brain is chaos, all I can do is try to keep breathing. It’s like being in transition during labor, but without the hope of a baby at the end. All I can hope is that at some point the pain will end, and I can sleep. An abstract belief that there is a Divine presence with me doesn’t make the pain stop. It doesn’t make it less. So telling me, “God is with you,” feels a lot like telling the naked starving person “Go in peace, be warmed and well fed.” (James 2:17.)

I am alone. And it’s not anybody’s fault. Nobody– not even my husband– can be there for me all the time. People have lives, jobs, kids, responsibilities. They have their own difficulties and issues that absorb their time and attention and energy.

But what I am trying to say is that telling someone in a mental health crisis “you’re not alone” is really just something you’re saying to make yourself feel better about signing off the conversation. Because unless you or someone else is willing to move into that person’s house and sit with them and comfort them and carry their pain through every single brain explosion, and help them pick up the pieces of their lives in between explosions, then yes, they are alone.

And maybe honest mental health care needs to start there. Instead of inspirational posters telling us “you’re never alone”, we need acknowledgement that yes, we are. As uncomfortable as it is for everybody else, I need you to face the fact that my mental illness puts me in solitary confinement. And if we can acknowledge that, then maybe we can start figuring out how to make existence in that loneliness at least bearable enough to continue. I need reasons to live, and ways to make living possible.

Last night, after a nuclear explosion in my brain, I lay in bed and told myself that my reason to live was that I ordered some new scrapbook paper and I want to live until I can see it. And then I thought about my kids, and told myself I want to live to see what they do when they grow up. And I told myself that as traumatic as it might be for them to grow up with a mom whose mental health is shit a lot of the time, it still wouldn’t be as traumatic as growing up in the shadow of their mother’s suicide. The loneliness is worth bearing for their sake.  And if I can make it, then when they have issues because of my issues, I can meet them in that broken space and say, hey, this is familiar territory for me. And I’m here to listen. And here’s what I’ve learned that might help.

*** I have gotten some gentle feedback on Facebook, and I want to apologize if I have hurt anyone in the way I’ve talked about cancer. It is in no way my intention to invalidate anybody’s suffering. Cancer sucks. Mental illness sucks. Pain is not a hierarchy, and I don’t wish either of them on anybody. When I say “I wish I had cancer” what I’m trying to convey is that I long for the kind of support system that I’ve seen some people with cancer get. I know that many others don’t have a support system, and they also suffer alone. And that is terrible too.