My step-dad said to me recently, “When it comes to mental illness, comorbidity is the name of the game.” He wasn’t wrong.
Comorbidity refers to having more than one chronic illness at once. Of all the people who experience mental disorders in the U.S. (roughly one in five), 45% of them meet the criteria for two or more disorders. That’s almost one in ten people who may be dealing with simultaneous mental illnesses.
Despite its prevalence, most of us go our entire lives without encountering the term. Even in a medical treatment setting, I had never heard that word. It was my own research and exploration that finally exposed me to the concept. Only then did I find any specialized information on what living with multiple mental disorders might mean.
Disturbingly, my experience is not the exception. I have comorbid mental disorders, but so does every single member of my family. My partner, and all of my closest friends do, too. Yet none of us have received adequate resources for this fundamental problem.
To me, this is totally baffling. Does it not matter that our minds are not only unwell, but layered with illness? Are we supposed to believe that the intersection of distinct mental illnesses doesn’t present its own challenge?
I see this as an urgent disability justice issue, and I believe that our work as intersectional activists cannot be complete without acknowledging this problem and amplifying the explicit discussion of comorbidity.
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Everyone in my life deals with comorbidity. Between my immediate family and my closest friends, we run the gambit from PTSD to autism, OCD to schizophrenia, addiction to eating disorders, borderline to bipolar, and more. Not only does each of us have more than one disorder, all of us have three or more. I’m involved, to varying degrees, with just about all of them. Sometimes I feel as though I’m juggling responsibility for so many mental disorders that they are all about to come crashing down on me.
What this means is that I have seen comorbidity in action at many different levels and from many different perspectives. Above all I’ve learned that if you are a person with numerous simultaneous mental disorders, your needs are likely to be different and more intensive than the needs of others.
I’m here to tell you one thing: your unique struggles deserve dedicated attention.
For everyone else, here are seven things I want you to know about comorbidity, and seven things you can do to help.
- Comorbidity is complicated. No question has a simple answer. No problem has a simple cause, or a simple solution. No combination of illnesses manifests the same way twice. Even just getting the most pertinent diagnosis can be extremely difficult.
- It creates external barriers to treatment. Having comorbid mental disorders means that no one treatment will ever suffice. Finding treatments that work well for you and well with one another can be a huge challenge, especially since treatments for different disorders often contradict and counteract one another. For instance, stimulant medications that are used to treat things like A.D.D. can aggravate anxiety and anger management problems. Balancing dissimilar treatments involves an extremely tedious and burdensome trial-and-error process that can make suitable treatments inaccessible, and that can give rise to unpleasant and disruptive side effects.
- It creates internal barriers to treatment. One illness is often a direct barrier to treating another. There are many things I absolutely must do if I am to improve on my depression and ADD, but I am prevented from doing them because of triggers associated with my PTSD. Similarly, some of the actions I take to improve one disorder can also aggravate another. I see this play out daily as I try to establish a routine in which I leave the house. It’s good and necessary in so many ways, but just being in public can be terribly triggering. Healing under these circumstances is a matter of constant negotiation and internal conflict.
- It often involves compounding symptoms. Problems I have often compound one another outright. Avoidance, for example, is a symptom common to many disorders. I may be avoidant of something important because of my A.D.D., my depression, and my P.T.S.D. all at once, making me avoidant cubed. Similarly, triggers can loop back and feed into one another. A dysfunctional thought process gets started because of one thing and triggers another seemingly irrelevant issue. Sometimes I am experiencing so many conflicting symptoms at once that my brain just shuts down.
- Our self-understanding is constantly evolving. For a long time I thought I just had A.D.D. and depression. Then, through research, I realized many of my symptoms could also be explained by P.T.S.D. This prompted me to reevaluate my past experiences through the lens of trauma, and found it incredibly healing. The realization itself, however, was a huge mindfuck, and it involved totally reorienting all of my treatments and many aspects of my lifestyle. Sometimes it seems like a new diagnosis could crop up at any moment, and when one does it can be severely taxing.
- Our illnesses evolve, too. New illnesses can evolve out of old ones, in combination with psychosocial environmental factors. One mental illness can also directly cause others to arise. P.T.S.D., for example, commonly evolves into Generalized Anxiety Disorder, Social Anxiety Disorder, addictive disorders, eating disorders, self-injury disorders, and more. Just recently someone very close to me began an extremely intense manic episode for the first time in their life, when previously their symptoms were most consistent with trauma, A.D.D., and depression. They are fifty-nine years old. When you have multiple mental disorders, you never know what could happen or when.
- Comorbidity is its own trigger. All of these complications add up to be extremely stressful. The challenge of facing comorbidity is itself debilitating, depleting, and demoralizing. It aggravates my depression by triggering a profound sense of hopelessness that is hard to overcome. It makes me feel defective and worthless, as though I am a lost cause, and as though the cards are always stacked against me.
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Facing comorbidity is an uphill battle, but a little support can go a long way. Here is what you can do, both for those who are close to you and for the community at large:
- Understand and learn. Research is your best friend. Listening is paramount. You can offer a world of support just by informing yourself about a person’s experience. Bridging gaps in understanding will allow you to better empathize with a person, better anticipate their needs, and better communicate with them on their own terms. Such gestures have helped me feel less isolated, more worthwhile, and more willing to turn to others for help. On the other hand, assuming you know the particulars of someone’s reality without investing dedicated, sincere effort into understanding their truth is very damaging.
- Trust what we tell you about ourselves. Mistrust is a common reaction to the experiences that are entailed in mental illness. Be patient and accepting, and know that it is often we who have been mistrusted. If something we say about ourselves differs from your understanding of our condition(s), remember that mental illnesses manifest differently in everyone, and that certain factors that influence our symptoms may be unknown to you. Take us at our word – there’s a world of good to be done with just that.
- Use your abilities. You may be capable of doing things that others can’t, like compiling resources, making phone calls, or looking up treatment options. Sometimes these types of small tasks are all that stand in the way of healing. If someone you know is stalled in their healing because of the barriers their illnesses create, then consider doing some small tasks for them. It could be the difference between accessing treatment and continued suffering. I have felt so feeble in the past because there are so many “simple” things I am incapable of accomplishing, and no one who I turned to gave me help. When I finally met someone who was not only sympathetic to me, but who actually bridged the gaps, the difference that it made was life-changing.
- Leverage your privilege. Numerous systemic prejudices can become barriers to treatment. You probably can’t, say, pay for someone’s treatments (though if you can, that would be awesome). But maybe you can navigate the medical system more easily than them. White males, for instance, are much more likely to be taken seriously by medical professionals. Advocating for someone may be enough to ensure them a higher level of care.
- Check what you think you know. Never forget that a person’s issues are more complex than what they can convey to you. You’re not entitled to every detail. You will never know every experience and every thought that is shaping their psyche. Even if they communicate openly with you, their own understanding is always in development. Don’t fall into feeling like you know someone’s mental health issues like the back of your hand. You’ll only end up stifling further development.
- Become an advocate. Educate yourself on the broader social conditions that create mental illness. Activate yourself politically and work to disrupt the status quo. Consider taking a next step into community outreach. Learn about local mental health services and organizations and see if there are any you would be interested in supporting, either through donations or volunteer work. Crisis lines, for instance, are in critical demand, and volunteering as a crisis counselor is a significant, tangible contribution to healing in this community.
- Take care of yourself. Sometimes getting involved in someone’s healing process can feel like an absolute roller coaster, and can be extremely draining. It’s important to bear in mind that close proximity to severe symptoms of mental illness can be legitimately toxic. For every person who I have helped, I have also reached the point of having to set boundaries. Some folks have received that better than others, but I think we all benefit from exposure to the practice of boundary-setting. Doing this has preserved the space and energy that I need for my own growth and healing, which in turn ensures my continued ability to contribute to my community.