Why are my mental health issues socially acceptable – but not my family’s?

I grew up with an acute sense of how frightening and all-consuming psychotic illness can be

If you are going to be struck down with a mental health issue, I think there are some you might choose over others. I don’t say this lightly. I had a breakdown at 17 and spent the months afterwards throwing back anti-depressants and trying not to kill myself.

This was 2006: there weren’t the same conversations going on around mental health issues back then (or at least they weren’t going on near me). When I first got ill, I really had no idea what had gone wrong with me. I had not shown any prior signs at all, beyond a slight tendency to worry. Then almost overnight I became a wreck who couldn’t stop crying, and was afraid to leave the house.

What happened? I still don’t know. I imagine genetics played a role, though genetics are rarely the whole story.

My parents, as ill-equipped as I was to recognise depression, were baffled by the sudden change in me. I missed a chunk of school. It was my head of sixth form who finally suggested that I should be taken to see my GP. I don’t think this simple step had occurred to me or my parents before then. The GP took one look at me, prescribed anti-depressants, and suggested seeing a psychiatrist.

I recovered over time. My life since then has been great, and I’ve managed the occasional relapses well. It got bad again after I had a baby, but again I had medication – including antipsychotics to help me sleep – and lots of support, and gradually I got better.

The prognosis for depression is actually pretty good, if you are lucky enough to receive treatment and support. And crucially these days, there’s not the same stigma in admitting you’re suffering from depression and anxiety. Public figures have spoken out about their own experiences. There have been mental health awareness initiatives. Of course, I’m not saying there’s no longer any stigma at all, or that it’s easy to admit you’re depressed. Still, a lot of progress has been made.

I don’t think we should be too quick to pat ourselves on the back though. We tend to use “mental health” as a catch-all term, but there is a big difference between suffering from non-psychotic depression, as I do, and suffering from a psychotic disorder.

My dad’s aunt had schizophrenia, and I grew up with an acute sense of how frightening and all-consuming psychotic illness can be. I used to worry when I was first getting ill that I had inherited some kind of family curse; that I too would one day lose touch with reality. All things considered, I feel very lucky to have got depression rather than schizophrenia.

This isn’t only because the prognosis is bleaker for psychotic disorders than for non-psychotic disorders. It’s also because of how society responds. Psychotic disorders are poorly understood, and come with an extra level of cruelty beyond the personal suffering they inflict, because they are also deeply alienating: everyone is terrified of madness.

We don’t tend to hear much about psychotic episodes during workplace mental health initiatives, or features on mental health and self-care. I’m a writer, and I’ve spent time over the last few years researching people’s experiences of psychosis. A common theme was the sufferer’s sense of fear and shame. My most recent novel looks in part at this subject. I felt a responsibility to get it right, while also not making the experience too gruelling for the reader (the book is, somewhat improbably, a comedy).

The influence of social and environmental factors makes the stigma around psychotic illness more troubling. There is some evidence to suggest that people of migrant or minority ethnic background are more likely to suffer from a psychotic illness.

Research from the Race Equality Foundation notes that people from African Caribbean communities are three times more likely to be diagnosed with schizophrenia than any other group. Once in the system, there is also evidence of more inconsistent treatment and poorer outcomes for these groups. Some studies further show a link between lower socioeconomic status and an increased risk of psychotic illness, although the overall picture remains unclear.

So societal conversations around mental health issues sometimes feel disingenuous to me, because they often seem to focus on certain issues to the exclusion of others. This is not to pit one illness against another, nor to suggest anyone should feel delighted to develop depression (I have not had the time of my life with it). But I think it would be helpful to make more room at the table for those disorders that are perceived as less socially acceptable – and more frightening.

As long as we allow psychotic illnesses to remain the ugly step-sisters in this story, we increase the shame and isolation of those who suffer from them.

Rebecca Wait is the author of I’m Sorry You Feel That Way, published by riverrun