Mental Health: The Pitfalls of Being a High-Functioning Individual

A personal account from an Indian woman

My friends and colleagues often introduce me as someone who is “available via email at all time zones.” There have been days when I have managed to complete tasks by staying up at American time zones all the way through Australian, while catching up on my Indian projects, too. I barely sleep.

In the midst of my workload, I set aside time to do my workout for an hour on most days, and manage to stay on a personalised diet that I try not to cheat on. Despite how heavy or fatiguing the workout for the day is, unlike most self-help manuals, a warm shower does not put me to sleep. I would just resume where I left off. I have rarely missed deadlines and I despise waiting on others; and because of my many peeves, I have taught myself a lot of skills, thereby removing the hassle of dependency. 

I get by on most days with this lifestyle, but it is a gross neglect of my health, especially my mental health. And that’s what I want to focus on, as the number of mental illness cases increased by 20 percent since the coronavirus lockdown began in March, according to the Indian Psychiatry Society.

My hyper productivity is quite a distraction from the elephant in the room that I desperately ignore. Hitting me like a tonne of bricks at least once every month – sometimes more, but in slightly lower intensity – is crippling depression, terror-induced anxiety/nightmares and manic episodes triggered due to PTSD (Post Traumatic Stress Disorder). It drives me towards suicide ideation; and by the time I feel better, I fall into the vicious cycle of righteous indignation and self-loathing because I spent all that time paralysed in bed. I find myself trying to run away from the tiniest of triggers lest I end up getting sucked in by any or all of the possible afflictions. Of course, I fail. And repeatedly so.

Discussions about mental health in Indian families are non-existent. Mostly because it is the families that cause it in the first place, on some occasions. Mental illness manifests itself in various ways and our responses to it vary too. 

In my case, I shut down like a battery-drained phone. A limp body that drags around the house, eyes and face swollen due to terrifying nightmares and the resultant anxiety. Tiniest of things could drive me up the wall – a conversation, an email or some scene from a film. My brain processes everything with acute paranoia and spews a combination of angry, hysteric wailing accompanied by an instant pang of regret and ignominy. I suspect that most families would just take that for morbid disrespect or a case of “bad mood” – a thinly veiled sexist insult for a woman’s outbursts. This casual sexism extends outside of home, of course. I have been labelled hysterical and neurotic, a lot, just so others can be absolved for their shortcomings. Isn’t it just easier to call the woman crazy?

If it isn’t difficult enough to navigate life with depression in India, it is worse for high functioning individuals. It often goes unnoticed. Mostly because we are quite capable of denying it to ourselves, and carry on until we can’t anymore. “Depression may inhibit the desire for activity and action, but high functioning individuals tend to forge ahead in an effort to succeed with goals,” says psychotherapist Mayra Mendez. “The drive to accomplish often sustains action and moves high-functioning individuals towards getting things done.”

For many, the source for mental illness will forever elude them, and for some, it could be in their past. Traumatic events overwhelm the ordinary systems of care that give us a sense of control, connection and meaning. We feel and act as though our nervous systems have been disconnected from the present. This is especially true for me. My life has been riddled with various traumatic events, whose toxic remnants still haunt me. 

“Long after the danger is past, traumatised people relive the event as though it were continually recurring in the present,” Judith Lewis Herman, an American psychiatrist points out in her book, “Trauma and Recovery.” 

“They cannot resume the normal course of their lives, for the trauma repeatedly interrupts. It is as if time stops at the moment of trauma. The traumatic moment becomes encoded in an abnormal form of memory, which breaks spontaneously into consciousness, both as flashbacks during waking states and as traumatic nightmares during sleep.”

Given that my past holds horrifying events of sexual abuse and coercive control, even small, purportedly insignificant reminders evoke bad memories that return with all the vividness and emotional force of the original event. It makes matters worse when a seemingly outgoing, high functional “go-getter” ends up in a murky pool of tears and self-harm in a matter of seconds.

“The many symptoms of post-traumatic stress disorder fall into three main categories. These are called ‘hyperarousal,’ ‘intrusion,’ and ‘constriction.’ Hyperarousal reflects the persistent expectation of danger; intrusion reflects the indelible imprint of the traumatic moment; constriction reflects the numbing response of surrender,” says Herman.

I have lived with anxiety and depression pretty much my whole adult life, and have sought medical interventions with some success. But none of my struggles seem like a comprehensible concept to even my close family and loved ones. With the constant urge to resist an episode, high functioning individuals like me end up fixating on the job at hand at the onset of an episode. Even though an episode is inevitable, it just seems like a mere case of lack of perfection for onlookers. I get restless when something doesn’t go my way, and this often manifests as something akin to frustration on the job. If you are a woman, there is a good chance that these episodes often collide with the menstrual cycle. Premenstrual syndrome, as much as it is joked about, is a legitimate reason for suicide ideation for many women.

Despite the chronic nature of this illness, and the helplessness I deal with, any delay in a planned activity or a deadline makes it impossible for me to forgive myself. The trauma strikes in two ways. One, I relive the entire episode (whatever be the trigger) as if it were the first time, and two, I experience a dissociation that enables me to watch myself go through this trauma but with zero emotions. It is this complex nature of the human mind that makes it harder especially for high-functioning individuals to cope with any deviance in their plans. While I feel like my bed is about to engulf me due to the weight of my mental agony, I also find myself to be sniggering at me suspecting if I am maybe exaggerating it a bit, or hating myself for not putting up a fight.

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With PTSD, our bodies are always on the alert for danger. We do not have a normal baseline level of alert; instead, we have an elevated baseline of arousal. We have an extreme startle response to unexpected provocation, as well as an intense reaction to specific stimuli associated with any traumatic event from the past. For example, I can never tune out repetitive stimuli which other people must just see as a minor inconvenience. I find every single repetition of such an event as if it were a new, and dangerous, surprise. These aspects of our reaction to trauma is something almost nobody can accommodate or understand.

This increase in alertness persists even during sleep just as much as it is in the waking state, and that explains the numerous types of sleep disturbances. “People with posttraumatic stress disorder take longer to fall asleep, are more sensitive to noise, and awaken more frequently during the night than ordinary people. Thus traumatic events appear to recondition the human nervous system. Traumatic memories have a number of unusual qualities. They are not encoded like the ordinary memories of adults in a verbal, linear narrative that is assimilated into an ongoing life story,” says Herman.

When I finally get done with the day’s toil, I find excuses to stay up. I read or watch soaps online hoping that I can somehow evade sleep. But I also know that I have to redo the whole routine the following day across time zones; still I am terrified to sleep because of nightmares. I also spend an inordinate amount of time recalling all the “mistakes” and imperfections that I unwittingly ended up making. I think of all the things I could have done differently, with regrets from a college conversation still looming over me.

Many high-functioning individuals with mental illnesses get on with their lives quite well. It is impossible, and wrong to paint a generalised picture of those experiencing an illness to exhibit same/similar outcomes. I have been open about my mental health and have advocated for more honest conversations for many years now. But I still find myself not being able to understand another person’s trauma. I can sympathise with someone who experiences something similar, at best. I have learnt and understood that every trauma is unique and so is the isolation because of that.

Many psychological journals say a supportive environment could offer a great path to recovery. But I find myself in a contentious position because I feel that nobody has successfully understood what goes on in the minds of high functioning depression/PTSD patients. Therefore, continuing to coexist in a society has caused me more harm than good. Perhaps that’s why I am great at hiding. I can stand on the frontline of a protest, organise rallies and galvanise people while I am involved in activism. But I am fully capable of digging myself a hole and cut every human interaction at the slightest provocation.

In India, being a woman is bad enough, imagine being an overworking, perfection-seeking taskmaster – it is as if I am begging to be hated more. I have learnt to work in a system which I believe is indifferent to my woes.

While we wage a lone battle with the monsters in our heads, perhaps it is best to reconcile with the fact that it is in fact going to be lonely.

StoriesAsia, a collective of independent journalists from 16 South Asian and Southeast Asian countries, seeks to replace the present-day parade of faceless numbers with humanising narrative nonfiction – a largely ignored journalistic genre in the region.

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