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?
I have episodes of both mania and depression, but depression is obviously the worst to deal with. My depressive episodes don't allow me to do anything at all. I just want to stay in bed so writing is not possible. Even brushing my teeth is impossible. My depressions are debilitating, but fortunately over the last couple of years I have found ways to battle it and have actually been able to write even when I'm starting to fall under its influence. The most challenging aspect of it is getting out of it. It's really difficult for me to pull myself out of my darkness.
What are some specific things you do to manage your illness that you find effective?
The horrific thing about depression is you can go in such a deep hole and get into a dark place that nothing or no one can get you out. So I have to really work hard to not go to the dark spaces. To do this I force myself to call or write someone I love, so really the most important thing for me to do at the onset of a depression is reaching out to my close long-term friends and/or family who know and/or understand my illness. This helps me get out of my sad little orbit.
I also am pretty fanatic about having to know my schedule each day. So every night and each morning I have to have a general plan of what I'm going to do each hour or half hour; this helps me have a routine and a purpose. If I don't have a purpose that makes me feel even more depressed. I probably spend way too much time making lists.
Seeing my therapist once a week is also critical. He is a relational psychotherapist and I've been seeing him now for two years.
I used to do Kundalini yoga with an incredible teacher but she left the city. I prefer Pilates now because it's so physical and I don't have time to think about anything, only my breathing. A new thing that I really like doing is going to a community sound meditation workshop that takes place in downtown Manhattan. It's difficult for me to relax so listening to those singing bowls and singing along with the sruti boxes really calms me down. I would never think I would be into such things, but at this point anything that will help me try and relax I will try. Ultimately I think the most important things that I do that help me manage my illness on a consistent basis are going to therapy and just making my work.
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 started therapy when I was 12 years old with a therapist I really liked. I felt like she helped me until she told me she could help me no longer and referred me to a psychiatrist. I was 15 and I felt very rejected. I never saw her again. The psychiatrist wasn't helpful but referred me to adult group therapy and I guess that helped me see that many people suffered with depression and anxiety; I was also put on anti-depressants and anti-anxiety medication at that time. I eventually got off of them when I found they were making me feel like i was living in a fog. Xanax did help me, however and when I no longer had a prescription, I would ask my grandmother (who also suffered from anxiety and depression) or mother for some if I was ever nervous. After college, I had a major breakdown and immediately saw a psychiatrist who diagnosed me with cyclothymia (a milder version of manic depression) and I was on Celexa and Depakote for several years and when I didn't have health insurance, I would get pills from friends or family members and would self-medicate. Once I called my psychiatrist cousin for a prescription and he didn't help me, so when I couldn't get meds it was often frustrating for me.
But then again, that was the period when I was self-medicating. It was surprising though through my persistence and socializing how many pills I could get at parties and through strangers. When I didn't have health insurance, I went to therapy through psychotherapeutic organizations offered in the city for sliding-scale fees. The therapists were usually social workers and I went through a few of them--decent to terrible. It's been nearly ten years now that I've been completely off any kind of medication so I don't have to worry about paying for it. Unfortunately, my current therapist doesn't accept insurance at all and is very expensive. I work an extra job (one night a week) right now just to cover his fees.
When do you struggle most with self-care? When do you find it easier?
If I am in a deep dark space, it is the most difficult to do anything for myself. I have to really pull myself out if it and like I said, I do my best to reach out to other people so they can help me to help myself. Extreme temperatures during the winter and summer are the worst. Fortunately, I have managed my depression much better these last several years. But the big depressions do come and when they do I am incompetent. I find it easier too look after myself when I'm having neither a depressed nor manic episode--when I'm more balanced and matter-of-fact about the world. In times like these I can handle self-care much better.
What kind of relationship do you have to your illness? Does how you think about it change the way you live with it?
It helps me to know that I am not alone with my illness. Even though I think of it as an ancestral disease (I have several family members who suffer from depression) I also think of it as a way to help my work. For instance, when I'm having one of my more manic episodes, I can get a significant amount of work done. I do still struggle with accepting the fact that I do live with a manic-depression. Years ago, I was given Kay Redfield Jamison's Touched by Fire: Manic-Depressive illness and the Artistic Temperament. In the appendix she has sections divided into poets, writers, visual artists and musicians/composers, and indicates which of these artists were in a mental institution/asylum, committed suicide, or attempted suicide.
Going back to this table helps me from time to time and so does reading her clinical and diagnostic criteria for mood disorders. If I'm starting to feel a bit off, on the verge of something that's not really healthy, I'll read, "Irritable-angry-explosive outbursts that alienate loved ones" and it will remind me, oh right, that's one of my behavioral manifestations! It helps me clarify my dysfunctional sides. A close friend of mine who was also an artist killed herself a couple of years ago. She was going through something very severe and spiraled downward quickly. It devastated me in a way nothing ever had before and I saw how it affected her family and friends. I thought I would never ever want to do that with anyone so I do try hard to fight it as much as I can. It's a constant struggle.
What's most useful for you in terms of support from other people? Is outside support important for you?
Outside support is essential to me--from my friends and my current therapist.
How do you negotiate the balance between self-care and making work and working?
As I get older I find it more difficult to begin to make work. I really, really have to force myself to do it. Just starting is the most challenging. I cry, or I get hysterical, or I put on lipstick, or maybe I put on a bathrobe and reel about something and then somehow it just starts. I realize I need to give myself the freedom to just stare into space or at a blank page or sheet of paper. Once I give myself permission I can start. And once I do begin and am finally in my process, for the most part I feel sane (the way I know sanity to feel) and eventually I do stay focused. If I didn't force myself to make work and stay with it, it would be incredibly difficult for me to function.
Elia Osuna is the author of two novels and a radio play. She is trained as a mezzo-soprano, is the co-founder of the record label and arts collaborative Ö and currently lives in New York City.