Can you talk a little about the ways in which your illness works as a barrier to writing? What are some of the specific challenges you deal with?
When I'm extremely depressed, it's difficult to do anything, let alone write, let alone write well. I'm usually not bothering to eat, or clean myself, or other basic things, and thus having to sit down and force myself to work goes poorly. Everything I do takes forever, and everything I turn out is crap, and I feel awkward turning it in to editors, but it's all I have--and that in turn feeds depression. On the flip side, when I'm manic, writing isn't really a problem, but I get so urgent and flaily that it's hard to write thoughtful, well-considered, articulate pieces. In both cases, getting any work done on private projects is just not going to happen, although I have dozens of half-started novel ideas developed in manic phases and later set aside as the absolute garbage they are. As for petty things like fact checking? Pffft.
And, of course, constant anxiety runs under everything--it's not so much a barrier to writing as it is a barrier to putting my work out there, to being assertive, to interacting with editors and other publishing and journalism professionals. Plus, being on submission like I am right now with a fiction project means the anxiety is at a fever pitch, and I spend way too much time alone with really ridiculous thoughts, convincing myself my book is terrible and every editor who rejects it hates it (not, you know, rejects it because she has a huge list and has to be selective and thus has to turn down great stuff sometimes, or because it's not quite a fit with her, or because she's already publishing something similar).
What are some specific things you do to manage your illness that you find effective?
I have really benefited from the use of medication to address some of the chemical imbalances in my brain that literally make me crazy. (Haha.) In the past, therapy has been really helpful. Also doing things like scheduling my time effectively and setting goals for the week, so I have a finite set of activities and I have clear boundaries on working hours (in the past, I've gotten into really unhealthy dynamics where I just work all the time). Being more open to friends about my mental illness and things they should be aware of when interacting with me--which doesn't mean asking for a freebie pass to be a jerk, but does mean openly discussing that sometimes there are things they can do to help me that will be really appreciated. Setting up some basic self-care parameters in terms of what I read and how I interact online has really helped too, because I had an extremely unhealthy relationship with the Internet for many years.
Managing my time carefully is theoretically effective for me as well, but I have a really difficult time with it even when I'm feeling well. Are there specific things you do that help you stay on a schedule?
So, I actually find Evernote really useful for this. I set up a checklist at the start of every week with a detailed day-by-day breakdown of what I need to do and in what order, and I also use my calendar to manage larger things. I try not to beat myself up over things--like today, I slept in until ten, had a hard time getting out of bed, and didn't start work until noon. Does that mean I have to work a little late? Yes, but I'm not going to be mad at myself for sleeping because my body obviously needed it. If my schedule does need to change, I'm careful to build in the change (although I admit that I tend to get really anxious and upset when it's shifted on me mid-week, especially by the demands of other people).
What is your relationship to more traditional models of managing illness, like therapy and/or medication? Do you find them effective? Is accessing them an issue for you?
I find both therapy and medication effective in my case, although I know that mileage with these treatment options is highly variable. I dislike a culture that simultaneously pressures mentally ill people to use these treatments and then shames them for doing it--everyone needs to find the treatment modalities that work for them, and that can take weeks, months, or even years. In terms of access, I had a nightmare trying to get onto medication; I had to fight for six months to even get an appointment at the community clinic with a medications management nurse who could work with me. This is a documented issue in Mendocino County, where many people seeking care are denied and unless you have the determination (and mental status) to fight for it, you won't get it. This is also, of course, the county that experienced a shooting incident followed by a month-long manhunt that ended in law enforcement shooting a mentally ill man in the back, and seriously considered enacting Laura's Law (one of several compulsory medication laws in the US) as a result--because obviously forcing people to take medication is totally logical instead of improving access to mental health services so people never get to that point. Ahem. I am digressing.
In terms of therapy, the real barrier to access is cost. Therapy is extremely expensive and many therapists refuse to take insurance/aren't covered by insurance. (Not that I have insurance…in fact, even though I'm trying my hardest to comply with the Obamacare mandate, thanks to Covered California's delays, I still don't have insurance!) Theoretically mental health parity laws are supposed to improve insurance coverage, but that doesn't mean therapists are going to jump to start processing insurance.
Right, this is such a challenging piece--because managing medications is an ongoing process that's unbelievably expensive out-of-pocket. (Which is not a question, just a frustration.)
Frustration, shared. I got really lucky because my meds manager gave me a government discount card even though I'm not really eligible, and my meds are still expensive. It can be really frustrating if you have to try a bunch of different medications to find the ones that work, because it starts to feel like money down the drain as your bathroom cabinet begins to look like a small pharmacy. Sometimes you can get compassionate use or samples, and I wish that was more heavily emphasised and also made available for people just getting onto meds. (Of course, there's also the danger of abruptly going off--one of my meds will cause seizures if I stop taking it suddenly, which means that I HAVE to make sure my prescription is filled at all costs.)
When do you struggle most with self-care? When do you find it easier?
When I'm stressed out with too much work on my plate, when I'm fatigued, when I'm on a tight deadline, it's really hard to remember even the most basic of self-care (DON'T CLICK THAT LINK, S.E.). In other words, usually at the times I most critically need it. And, of course, it's easiest when I'm healthy, because I can keep focusing on making healthy decisions for myself.
What kind of relationship do you have to your illness? Does how you think about it change the way you live with it?
My illness is an inextricable part of me. It doesn't define me, but it's part of my definition; I wouldn't be the person I am without it. And it's not a blessing or some sort of magical things, as many people seem to think with mental illness and creative people--my mental illness doesn't make me any more creative than eating lentils for dinner does. It's just a thing that I live with, and something I manage to make sure it doesn't eat me alive, which it often very much wants to do--I've compared it to a monster inside me, but it's also like a tiger in my living room. Content to sit around not doing much of anything, until it decides to do something, and you can't predict when that's going to happen. Living in a culture where having a tiger in your living room is something to be ashamed of, I've been forced to deal with a lot of internalised stigma and self-hate about being mentally ill, to come to terms with that and to be able to comfortably say 'I'm mentally ill. It's a thing. I deal with it.'
Sometimes I get very frustrated and feel as though I need to constantly double-check emotions and reactions, asking myself if this is The Crazy talking, or a completely valid response. I jokingly call this process the sanity check (thanks, mathematicians, really), and what started out as a tool for questioning my motivations has become a great tool for self-reflection, thinking before I speak, and owning my emotions. A friend of mine carelessly commented the other day that crazy people shouldn't be hired by the CIA because we'd be terrible with impulse control and state secrets (there was a lead up to this, I promise), and I thought it was just the opposite--because we've spent so long learning how to evaluate emotions and situations to maintain control, we're about the safest people in the world.
It sounds like how you think about your illness has evolved quite a bit over time. Would you say that's accurate? What spurred that evolution?
Very accurate! A big part of what spurred that shift was getting into disability politics and the mental health movement, where I found fellow disabled people and those resisting dominant paradigms. It was very eye-opening for me to discover that there were a lot more of us than I realised, that we were here, we were crazy, and people were just going to have to get used to it. I owe, literally, my life to the disability rights movement, not just for all the great things it's done for disabled people, but for how much it touched me personally.
What's most useful for you in terms of support from other people? Is outside support important for you?
Sometimes I just need people to leave me alone. Sometimes I need people to come hang out and play Scrabble with me, and to not embroil me in conversations about work--I love my work and love what I do, but being a journalist who focuses on social justice and cultural issues doesn't mean I want to talk about these things all the time. Sometimes I just want to play Cards Against Humanity. I have a fantastic network of friends who are wonderful and amazing when I need to rant about something--which I think is an emotion common to all of us, not just us crazies. These people will feed me when I'm being shite at self care, if I'm collected enough to ask them, and some of them do it without even having to be asked (the best, I love you, M!). Just affirming that I'm a human being with value is sometimes so important.
The one thing I don't need from my friends and loved ones is therapy, which is something many of them seem to think they should be providing. While I definitely have conversations about feelings and emotions with friends, those are about specific things: like, say, an emotional issue I want to address. I prefer working with a therapist on larger issues because of the barrier of professionalism, the fact that the therapist is trained, the fact that therapy is intended to get deep and messy and vulnerable but it takes place in an atmosphere of trust. I want to be able to work through my issues with someone I'm not going to be tickling on a couch later, you know?
Did it take you a long time to find a therapist with whom you could have that kind of relationship?
Actually, no! I was forced into therapy as a child (please don't do this, people, forced therapy is no more effective than forced meds) and it went poorly, as one might expect, but when I sought out a therapist on my own, I found the right one on the first try. I realise this is practically unheard of, and I'm really glad it worked out the way it did. Sadly, Steve isn't going to be covered by my as-yet hypothetical insurance, so I'll have to find a new therapist with [Insurer], and I'm a bit curious to see how that goes. And by curious I mean 'dreading.'
You're also a freelancer--how do you negotiate the balance between self-care and writing for love and writing for work? Is there a particular aspect of that balance that's most challenging for you, and how do you navigate it?
Aaaagh story of my life. It's a constant juggling act and in recent months writing for work has definitely been winning. For me, I budget energy and time to paid work first, since obviously I need money to survive, but also because I take a pride in always turning work in polished and on time--I have yet to miss a deadline, and I want to keep it that way. I want a reputation for being reliable and easygoing, because that gets me more work, but it's also just a personal thing--missteps, for me, tend to lead to falls. (I also confess that a part of me wants to make a point about mental illness and employment--that along with other disabled people, we are perfectly capable of working and being good at what we do.) And sometimes work ends up eating everything, and thus I barely have any time to write for love. (I've been sneakily including writing for love on my personal website over the years, but things like long form fiction aren't suited to that platform--luckily, when I do sit down to do that, I bang out a draft pretty fast.)
Unfortunately, I'm still not very good at integrating self-care into this whole process. If getting work done means staying on the computer later than I'm supposed to, or forgetting lunch and then wondering why I am dizzy and nauseated, I will--and I need to come up with a more functional way to address that. Much like larger questions of managing mental illness, there is no magic solution, and everyone's best approach varies. Clearly, I need to look harder for mine.
photo: Brendan McGuigan
s.e. smith is a writer, agitator, and commentator based in Northern California, with a journalistic focus on social issues, particularly gender, prison reform, disability rights, environmental justice, queerness, class, and the intersections thereof, with a special interest in rural subjects. International publication credits include work for the Sydney Morning Herald, The Guardian, and AlterNet, among many other news outlets and magazines. Assisted by cats Loki and Leila, smith lives in Fort Bragg, California.