Mental Health

 Hey y'all!

Well, this is definitely the longest I've ever gone without posting.  Geez.  I don't really have an excuse, except, like... quarantine?  Life?  I don't even know.  I've been simultaneously busy and bored for the past seven months.  But here I am!

This post is one I've written and rewritten in my head several times.  It's also a topic I've addressed a bit in some of my other posts, because it's inextricably linked to T1D.  Any chronic condition, whether visible or invisible, has a profound effect on mental health, and T1 is no exception.  There are several factors at play here, so let's break them down a little.

*Trigger warning: This post deals with a lot of discussion about mental health issues, including anxiety, depression, and eating disorders.  Take care of yourselves y'all!*

First: The trauma of diagnosis.  This is one that's not discussed often, even within the DOC.  Many PWD are diagnosed at a young age, and most of the time that diagnosis doesn't occur until after they've gone into DKA and their organs are failing.  When I was diagnosed, I spent several days in the ICU, and as a 7-year-old who was terrified of needles and hated being sick (just like most kids), the whole experience was incredibly traumatic.  I still can't walk into Evanston hospital without getting flashbacks.  I still panic every time my brother says he's not feeling well.  That stuff stays with you long after you think you've moved on.

And then there's the whole "living with it" part.  Every single person with T1D knows the feeling of mental exhaustion that so often precedes burnout.  I once heard it described like this: Put your arms straight out in front of you, like you're reaching for something.  Hold that position for as long as you can.  Eventually, you reach a point where you wanna put your arms down, right?  Your muscles are tired; you want to relax.  Now imagine how it would feel if you could never break that position--or maybe you could, but it would have life-threatening consequences.

Ok, maybe not the most sophisticated metaphor.  But the point is, living with a chronic condition like T1D is exhausting, physically and mentally.  From the minute you wake up until the minute you go to bed, you have to make a conscious effort to keep yourself alive, not to mention enduring the physical pain of injections and infusions.  One study done by Stanford University found that people with T1D have to make an average of 180 extra decisions EVERY DAY as a result of their condition.  Yeah, you read that right.  Every day.  No break.  No rest.

As you can imagine, living with this constant stress puts PWD at a significantly higher risk for mental health issues like anxiety and depression.  Not surprising, if you think about it.  We have to make so many decisions every day, and each one could literally be the difference between life and death.  I know it sounds like I'm exaggerating--but y'all know I'm not.  Living with that mindset, never being able to relax, viewing new situations through a lens of danger--it's easy to see how that can lead to anxiety.

And of course, depression and burnout go hand in hand.  For those of y'all who don't know about burnout... it's one of the worst things a PWD can go through, and also one of the most common.  Burnout is the feeling of giving up, the feeling that even though you know you should check your blood sugar or take insulin, you just can't.  You know it's dangerous, you know you'll feel better if you do it, but you just don't care because you're so tired of being sick and tired of needles and stress and all of it.  Every PWD that I've known has faced burnout to some extent, though it's more severe for some than others.

There's also the feeling of being a burden--again, something that pretty much every PWD faces at some point.  Sometimes it happens when you look at your family's medical bills and think about how much you cost them every month.  Sometimes it happens when you can't engage in a social gathering because you're busy treating a hypo or taking insulin.  Sometimes it happens when a friend or partner tells you that they're worried about you, and your first reaction is guilt for hurting them.  That stuff weighs on you.

Anxiety and depression are some of the more common mental health issues faced by PWD, but they're certainly not the only ones.  Some folks with T1D develop a condition called "diabulimia"--a type of eating disorder--in which they deliberately skip insulin doses in order to lose weight.  Why does this happen?  Well, aside from the pressure our society places on young people to look a certain way, there's also the added stigma that comes along with T1D.  When a young adult has a condition that's so often mischaracterized as a "fat person's disease" (there are so many things wrong with this stereotype, btw), they may start to feel self-conscious about their weight.  That, combined with burnout, makes it all too easy for them to develop diabulimia.

So why am I writing about all this?  Well, to educate, I guess.  Y'all know I don't want any sympathy, but it's so important for non-PWD to be educated on this stuff.  T1D is an invisible illness, so we all--myself included--have a tendency to put on a brave face and hide our struggles at times.  Like, I got 2 hours of sleep last night because I was up till 4am with an urgent low and then woke up with another one at 6:30.  For me, that's just a day in the life, ya know?  But I'm sure my teachers and classmates were wondering why I seemed tired or unfocused.  I feel guilty on the days when T1D stops me from being productive or helpful, but there's nothing I can do about it, and a little patience from the folks around me goes such a long way.

And of course, I'm writing this for my amazing T1D family--my Pin Cushions, my Diabuddies, my CC19 delegates.  Whatever that voice in your head is telling you, you are perfect and worthy and not a burden.  And yeah, things will get better.  Trust me.  You're not alone.