Tragic and inspirational are the two words that come to mind after reading SJ Hart’s book, Lies In Silence. SJ Hart has a unique experience when it comes to these issues because she is someone with bipolar disorder, a parent, and a clinician, all of which will be explored in upcoming interviews. Hart tells the compelling story explaining the heartbreaking impacts bipolar and co-occurring disorders had on her family. The more I learned about this family and their battles, the more inspired I was to share her story with others.
SWH: On page 101 you explained, “There are millions of families like mine. I think about the many clients over the years that undoubtedly had similar severe mental illness. The millions who lie in silence and remain voiceless, suffering from addictions to gambling, drugs, alcohol, shopping, food, and sex”. In your opinion can you name those things in your family that lie in silence?
SJ: Well I have to start with our genetics and the amount of illness that has been transmitted from generation to generation. It does appear that the severity and the lowering age of onset increases, making treatment difficult and complicated. Like the Hemingway family as an example, the random crises lie in silence with the potential symptom of deep hopelessness and suicide, and/or violence and hurting other people.
Not only does all of that lie in silence, it is also invisible and random. One other important point is that people lie in silence; Family members, friends, professionals, and the medical community. Our family did not discuss the obvious issues and our culture back then, and even now also remain silent about illness that is no one’s fault, bringing loneliness and the feeling of being broken.
SWH: Your father’s story was very moving as well as tragic, yet you chose to use it for education in regards to the details of his struggle with bipolar disorder (manic-depressive disorder). How did you make that difficult decision while writing the book?
SJ: It took me decades of quality professional therapy, and doing some work on my own to grasp how an illness can take over your life and become who you are, in spite of all factors including intelligence, personality, compassion, etc. I knew more about my sick and violent father, than about gentle and thoughtful man he was. So, I investigated by interviewing family members. It really wasn’t until I got sick, which is detailed in the book, that I really understood how dramatic and profound mental illness can be, and his was severe. I wanted to demonstrate the biological and internal change and the situational external change. They occur simultaneously. I personally believe this continues to be misunderstood. The only way I know to shift change is by speaking so others can learn. It wasn’t a matter of if I should teach it was when I would teach.
SWH: How did the stigma attributed to mental illness impact the rest of your family prior to your father’s passing?
SJ: We became disconnected from our extended family and our community. His family did not believe there was anything wrong with him, which decreased the amount of people who could help in our desperate situation. It was the beginning of our devastating new normal, and my mother really loved him before he got sick. Later on I understood more about the impact it must have had on her.
SWH: Many of the experiences regarding mental health in your family point to the argument of nature vs. nurture, particularly genetics. Today there has been a lot of talk about biopsychsocial influences of mental illnesses. What are some of the biological, sociological, and psychological effectors of your mental illness?
SJ: Well that is fairly complicated. I was 43 when I had an acute onset of bipolar disorder, after being prescribed a medication for migraine prevention. I had recently had a mild stroke triggered by a migraine, so my neurologist wanted to lower the risk of subsequent migraines. Within days I started to have mood changes and in 6 months I crashed into a black, suicidal depression. I also wrote about that so it is clear how my onset occurred. My children had some vague mood symptoms that could be attributed to hormones of childhood development, but were also catapulted into acute episodes by pharmaceuticals. Would any of us gotten sick without chemical agents? I tell my audiences that they are not questions that can be answered. Do we have genes? We know now that we do.
The short answer in my opinion is that it is not which one. It is all. My husband and I watch the news and are completely dismayed by the continued use of the statement “looking for the motive”. In cases where it is clearly mental illness involved, disease is not a motive, and one has to ask if any other diseases would be handled that way in regards to public insults. For instance recently an actress suddenly committed some vandalism, posted disturbing comments on social media, and was clearly not well. Yet many of the news outlets defined it as a publicity stunt. When she was finally involved in something where they could hold her, it was determined she had an acute onset of mental illness. Our culture should examine why they defined her actions as a publicity stunt. So again, for me it is all of the above. For some it is which came first. But honestly it doesn’t matter once it is here. It’s here.
SWH: What have you learned from your experience that can be helpful to someone who is also dealing with a family history of Bipolar and Co Occurring Disorders?
SJ: I am actually participating in a book soon to be released that addresses that as one of its questions.
- Read, Read, and Read – magazines, books, reputable websites, join an online support group with a credible history. Go to seminars, research professionals such as therapists and psychiatrists. We have fired many as they only understand the text book. Your insurance or private dollars pay their salaries so don’t settle.
- Participate in finding the right med cocktail. It is the difference between functioning v nonfunctioning, suffering v not suffering,
- Find the people in your life who get it, and when you feel up to it seek out people you do not yet know who get it. They will support that you are not broken.
- Don’t be silent. Find ways to stabilize and become an advocate. Nothing will change if we don’t challenge and speak. Our culture is way off the mark, and will continue to be unless we speak when we are able.
SWH: A lot of people go by the motto: I am not my mental illness. How did you learn to internalize your mental illness upon realizing the severity of it?
SJ: Oh boy. This is a lifetime process. I’ve always known my family members are not their mental illnesses, as well as me. No different than cancer, lupus, Parkinson’s, diabetes, asthma, epilepsy, etc. The big difference is that with any chronic illness is that they are chronic. It is a matter of developing ways to minimize the episodes with longer periods of remission. It is a battle that gives you only certain warnings, and as I say often it is not forgiving. I have had so much grief and trauma directly from mental illnesses. It has been with all of the people I love, and then eventually with me.
Each wave is just that. Some you can jump some knock you over, some you can see coming, and some come out of nowhere and you can’t catch your breath. Internalizing was immediate because I had children to care for, and that by far has been the saddest. However, when I crashed, I had a group of women that called me every hour on a rotation. A group of women who also lived it and I met in a support group for children. And they all said the same thing, “I love you. You need to be well for your children. They will not be able to stabilize while you are sick. Put the oxygen mask on yourself first.” They were right. Two of my three children are in treatment.
I’ve been a clinician for over thirty years. I’ve known mental illnesses my entire life. The severity changes sometimes day to day. The waves in chronic illness are about preparation, knowledge, support, resources, and connections. The biggest difference with chronic mental illnesses than physical is that our culture is uneducated, judgmental and lacks compassion. So…for those who remain silent now is a good time to find your voice. There are lessons in everyone’s story.