This is my first official post for National Invisible Chronic Illness Awareness Week (NICIAW). Today, I wanted to write about my reality: invisible chronic illnesses that are psychiatric.

First, some background. I have chronic depression and anxiety. Scientists have discovered that once a person has had one cycle of clinical depression, that person is more likely to have another cycle. The more cycles one has, the more likely it is that one will have more.

I cannot tell you how many cycles I’ve been through. I do know that since my breakdown in 2000, I have relapsed every year at least once. Some relapses are mild, but others are quite severe. None have been as severe as my breakdown in January of 2000 (thank the universe or whatever’s out there!), and I’ve heard many times in treatment that once we start treatment, we can never be in the same place again because we know more than we did at that time.

I’ve done many different kinds of therapy, the most helpful of which have been Cognitive Behavioural Therapy (CBT) and regular old talk therapy. I’ve done group therapy, which was important at the time, but I’d prefer not to have to go through it again. I’ve had psychiatrists and therapists, psychiatric nurses and occupational therapists. The important thing is to find the thing that works for you, with the “therapeutic person” that you have a connection with. As far as I know in Canada, psychiatrists mostly just prescribe medications, and don’t do a letyot of therapy. That means that a patient has to have some other variety of therapeutic person in order to do therapy. I firmly believe in the importance of therapy in the treatment of mental illness.

However, I also believe in the importance of medication. Depression can be caused by life circumstances; usually, this is the kind of depression that goes away with time, as those circumstances change. But depression is also caused by brain chemistry, and often medication is vital to changing that brain chemistry. I take more pills than I’ll list here, but I do know that I will always take an anti-depressant, for the rest of my life. My brain just doesn’t work as well without it.

And as far as anxiety goes, I believe the same thing: therapy is critical, and medication can be a lifesaver.

You can’t tell by looking at me that I have chronic depression and anxiety. Part of that is because I’ve probably had clinical depression since high school, if not earlier, and I developed a Mask. My Mask is one of competence, confidence, and capability. I have had literally YEARS of practice at appearing to be well (or at least okay and functioning) when I was in fact far from it. One of the phrases I particularly like is “hiding in plain sight”, which I read in someone’s blog. (Forgive me, lady blogger, I thought I’d bookmarked the post where you said that, but I apparently didn’t, and I can’t find it again. If you’re reading this, please let me know!)

One of the negative outcomes of having this kind of Mask is that it’s like a default position for me. I can assume my Mask in all but the most severe and dire relapses. This is hard for people to square with the idea that I am disabled and debilitated by my illnesses.

The Mask won’t stay on forever, though. It is a limited time coping mechanism. (And not a very good one, at that. I do not recommend it.) I can keep it up for a while, but after a couple of hours of smiling and nodding and seeming to be very capable, I will go home, collapse, and quite often cry for hours. And then I will be out of it for days.

When my anxiety is really high, the Mask slips somewhat. As I am writing this, I just received an email from an SPCA colleague of mine. We have our annual Walk for the Animals on Saturday the 13th, and I am in charge of the registration process and all of the money. This is Year Three of the challenge, and I haven’t been very happy with the way it’s worked either of the past two years. So my anxiety level is really high, and it obviously came through in the email I sent to her asking if she’d gather some materials for the booth at which she is working that day. Her response began, “Linds, relax a little.” I know I’m bad when my Mask doesn’t even work over email.

I’ll talk a bit more about the Mask in my next NICIAW post, which will be called Stigma and Scepticism.