The following is the final instalment of a four-part series on mental health focusing on depression, self harm and suicide.
A man rents a car, empties his bank account and drives several hours to a nearby city known for its nightlife and gambling, intent on ending his own life.
While that may sound a lot like the plot of the 1995 movie Leaving Las Vegas, it was very much real life for “Josh,” a Wellington County-area resident, in January of 2012.
“During a depressive episode, I left my parents’ house for what I thought was the last time,” Josh told the Advertiser. “I rented a car, left my cell phone behind, emptied my bank accounts and insurance policy, and then drove to Niagara Falls.”
Josh, now 36, had struggled with bipolar I disorder (manic depression) and attention deficit hyperactivity disorder (ADHD) for about 12 years before “hitting bottom” last January.
“I spent three days awake pacing in tears in a motel room trying to figure out if my family would be better off without me,” Josh said.
But thankfully, unlike Nicolas Cage’s character in Leaving Las Vegas and also John O’Brien, the author of the novel on which the movie is based, Josh’s story did not end during that fateful journey south.
“With much hesitation, I called my parents and told them ‘I don’t want to die’ and ‘I will do whatever it takes,’” said Josh.
When asked what was going through her mind for three days while Josh was missing, his mother Joanne boiled it down to one word.
“Despair,” she said. She explained Josh’s illness seemed to get progressively worse over a decade – until last year.
“It got to the point we were afraid to leave the house because we thought we’d come home to find him dead,” said Joanne. “We were in a living hell because we never knew what we were going to find.”
While many often associate bipolar disorder and severe depression with self harm, Dr. Raj Velamoor, interim medical director with the Wellington-Waterloo-Dufferin chapter of the Canadian Mental Health Association (CMHA), says developments in medication and intervention programs have reduced the number of suicide attempts in those patients.
Velamoor, also a professor of psychiatry at the Northern Ontario School of Medicine and professor emeritus at Western University, added, “[Suicide] is a devastating outcome of an introjective depression focussed on issues of self-worth, self-esteem, failure and guilt. Individuals who are highly self-critical and feel guilty and worthless are at considerable risk.”
He explained bipolar disorder is characterized by “pathological disturbances in mood, [which] can range from extreme elation, or mania, to severe depression.”
Though Josh was not diagnosed until the age of 23, looking back he believes his mental health issues likely began at a much younger age.
“When I was eight … my self-esteem was extremely low,” he said.
Dr. Velamoor says bipolar disorder “can be diagnosed from as young as preschool to anytime throughout adulthood,” but studies indicate approximately half of all cases are diagnosed between the late teens and the age of 25.
For Josh, a pattern of low self esteem continued for years. His first contact with a health professional occurred at age 15, yet for the next decade he continued to suffer – mostly in silence – with bouts of anxiety and depression, in addition to a yet-to-be-diagnosed case of ADHD.
His struggles were not easily detectable, as the outgoing and popular teen (and later, young man) had an active social life during high school and at Brock University, where he studied economics.
“[Josh] hid it for a long time,” Joanne said of her son’s illness.
Dr. Velamoor said that is not uncommon.
“This may be possible, as those with an outgoing and sociable personality may go unnoticed,” he said.
“Their mood swings may also be less severe. They may be characterized by others as being ‘passionate, energetic, on the go,’ etc. However, as their mood swings become more severe and frequent, it may become more obvious. It may also lead to lapses in judgment and social functioning that may be noticeable.”
For Josh, the combination of ADHD and depression started to take its toll during university.
“I could never sit still and attended about 10% of my university courses. I could not concentrate on the professor because I always had rapid thoughts and was constantly trying to sit still,” said Josh.
While he did fail a few courses, he was often able to learn from textbooks just days before exams and, surprisingly, could achieve positive results.
“ADHD causes a lack of focus, however, I could hyperfocus if there was a deadline or urgency because of adrenaline,” said Josh.
“I was never diagnosed with ADHD as a child because its commonly associated with learning disabilities, and I was intelligent.”
He was officially diagnosed with ADHD at 23 and put on Ritalin. While the medication seemed to lessen symptoms associated with the disorder, it did little to quell Josh’s depression.
“I always felt unhappy, but I could never put a finger on it specifically,” he said.
In university, he started having very “sad” periods and spoke regularly with a guidance counsellor. Eventually, the depression became overwhelming and Josh received treatment under his first psychiatrist at the age of 25.
“I was diagnosed … with major depression. After taking anti-depressants I experienced mania after a few months,” he said.
Manic episodes ultimately were followed by worsening depressive episodes, and he was placed in a psychiatric facility in Penetanguishene for three days. Then a new psychiatrist diagnosed Josh with bipolar disorder.
“I was then taken off anti-depressants and put on mood stabilizers to avoid any future manic episodes,” he said. “This new phase stopped any manic episodes, however, I was in a constant state of major depression for years.”
Throughout much of his ordeal Josh turned to self-medication, which went on for years through vices such as gambling, drugs, alcohol, prescription drug abuse, binge eating, irrational spending and even inhaling compressed air.
Dr. Velamoor says drug and alcohol abuse is extremely common for those suffering from bipolar disorder. In fact, he told the Advertiser, those individuals are eight times more likely than the general population to develop substance abuse problems.
Though it can be difficult to tell, Josh points to 1997-98, during his second year at Brock University, as the turning point when his alcohol and drug use crossed the line from experimental – and what some may even consider “normal” – to abusive.
“I was drinking or self-medicating (in private) more than all of my friends,” he said.
After graduating from Brock, Josh would “binge drink or not drink at all.” After age 25 he also tried a lot of drugs, preferring stimulants “because I associated these drugs with weight loss and being awake for days.”
At the age of 28, he had a seizure after consuming two grams of cocaine – alone – following the death of his dog.
For those suffering with bipolar, substance abuse – particularly with drugs like cocaine – can make diagnosis difficult.
“As street drugs are the greatest mimickers of psychiatric illness, diagnosis becomes extremely difficult in these individuals,” said Velamoor.
“Limiting and eventually stopping their use of these substances is vital to controlling their symptoms.”
He added, “Individuals with a bipolar disorder complicated by substance abuse have more severe clinical presentations and poorer treatment outcomes than their counterparts.”
They are also more susceptible to accidents, non-adherence to treatment, hospitalizations and suicide attempts.
“My case was very complex,” said Josh. “Over 12 years, I had five psychiatrists, was on 23 medications but nothing was helping. I was also seeing a cognitive behavioural therapist and an addiction counsellor for six years.”
According to Dr. Velamoor, there is often “a lag of a few years” before a person struggling with bipolar can be diagnosed with the disorder.
“This may be a cause for concern in light of data suggesting that early diagnosis and intervention may prevent the development of a more severe course of illness,” he noted.
For Josh, that evolution came in the form of serious thoughts about self harm.
He had “daydreamed” about self harm since he was eight years old, but it became much more of a reality about three years ago.
“I didn’t want to harm myself but I had no problem with wishing to die. For instance, fall asleep and never wake up,” Josh said.
“I used compressed air at this time. This took things to a whole other level, because I was aware that I could die at any time while using this.”
Velamoor says inhaling chemicals and substances is an indication of the severity of dependence – and using compressed air is rare.
In 2011 Josh spent time in the psychiatric ward at Brampton Civic Hospital, where he first met his current psychiatrist.
But after his release, and even with the help of a “great” physician, Josh continued to struggle – to the point he felt there was no alternative but to make his solo, one-way drive to Niagara Falls in early 2012.
When he changed his mind and instead decided to phone his parents for help, it was a major turning point in a decades-long battle with mental health issues.
“Ninety minutes later my parents arrived and I realized
the terror that they felt and I knew then that I wasn’t the only one suffering,” said Josh.
He signed over power of attorney to his parents and admitted himself again to the psychiatric ward of Brampton Civic Hospital. From May to July 2012 he spent another 11 weeks in the psychiatric ward.
Last spring his psychiatrist presented Josh’s case to the hospital’s chief psychiatrist and his colleagues, to discuss the possibility of electroconvulsive therapy (ECT) to deal with his symptoms. ECT involves electrically-inducing seizures in anesthetized patients. It is most often used as a “last resort” treatment for clinical depression that has not responded to other treatments.
In Josh’s case, the doctors voted against the treatment – “they were right,” he would later say – opting to instead try placing Josh in St. Leonard’s Place, Peel, a Brampton residential facility for men who suffer from severe mental illness. He moved into the facility last July after being discharged from the hospital.
The facility, one of a few of its kind in the province, focuses on integrating men into the workforce and ultimately helping them to lead healthy, independent lives.
“I got to move out of the hospital, out of my parents’ house so they can have a life without constant worry, and into a facility that can help me become stable and confident and prepare me for a real future, while looking after meds and finances,” said Josh of the facility.
Over the last 18 months, Josh has come a long way.
“St. Leonard’s has provided me with not just a place to live. It provides a community and I immediately felt welcome. It provides me with structure that I needed so bad,” he said.
The placement, he continued, “has helped me see that I am capable and deserving of success. I am very grateful and fortunate that they entered my life at just the right time.”
His mother Joanne agreed.
“Him living at St. Leonard’s has really saved his life – and ours,” she said. “It’s really helped him and made us feel more optimistic.”
It was only after he started to finally feel better that Josh realized the impact his mental health struggles have had on those close to him.
“When you are depressed, you are very self-absorbed because you can’t stop thinking of your depressive thoughts,” he explained. “I realized in my 30s the pain I had caused my family and close friends.”
Dr. Velamoor said life can be very difficult for those close to individuals suffering with mental illness.
“[It] can take a heavy toll on the families and loved ones. They may be affected in many ways,” he explained.
He noted they can experience anger (towards both the individual and their care providers), guilt, financial hardship, a sense of loss and “feelings of shame due to the shrinking of their social network on account of stigma.”
Joanne said the worst part was not being able to help her son, despite an immense desire to do so.
“You feel so helpless because you want to take away that pain from them,” she said. “It’s not an easy road for families to go through. Because of his illness, we’re ill too, because we’ve been living that life.”
In retrospect, Josh said he feels “horrible” about what his parents have gone through.
But, as is the case with many who suffer from mental health issues, Josh had to start his own recovery before he could repair his relationships with others. And while he believes he will rely on medication and other supports for the rest of his life, Josh and his family feel he is finally making progress.
“We know he has gotten better but he will always be dealing with it,” said Joanne.
Dr. Velamoor said he is confident patients like Josh can lead long, productive and otherwise healthy lives once properly diagnosed and treated.
“The future is promising … [but] We need to learn to focus on lives, not just symptoms and episodes. Our effectiveness should be measured not merely by relief from symptoms and suffering, but more importantly through significant positive changes in level of functioning.
“Only then can the individuals we have the privilege of serving feel integrated with the communities they live in and share in the collective hope that their lives are well lived and fulfilled.”
For Josh, that hope is becoming a reality. He is completing a bookkeeping program and is currently enrolled in a CGA accounting program – something that just one year ago seemed impossible.
“I have a sense of purpose and confidence that I will be able to live a normal life,” he said with a smile.
“I am finally feeling joy again – actually, joy that I cannot really recall having felt.”
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While the Advertiser’s four-part mental health series focused on personal stories, its purpose all along was to raise awareness about mental health issues in general. It is the paper’s hope that these stories illustrate that mental health issues can affect anyone, regardless of gender, age, background and socioeconomic status.
Respondents to a recent Advertiser poll felt three factors – failure to recognize illness, stigma/stereotypes, and lack of resources – play an equal role in preventing those suffering with mental health issues from seeking help. More programs and support will help, but there are many ways to get help right now. And it is up to everyone to help eliminate the stigma and stereotypes that often accompany mental illness.
Hopefully this series will help those suffering with mental health issues realize they are not alone and that help is available. Suffering in silence and self-harm should never be an option.
