7 December 2020

On Excavation - Revisiting Mental Health

Trigger Warning: borderline, substance abuse, self-harm

In solitude and in standstill, there is a sudden magnification of the inner life. Stripped of stimulation, activity, human contact and other forms of engagement or distraction, the mind begins a process of (violent) excavation, an unearthing of all that lays beneath the surface of everyday life and everyday demands. Compulsive patterns and behaviors intensify, latent or painful memories intrude the surface of consciousness.

After all, excavations are dangerous exercises, with unforeseeable casualties. Who or what will die in the process of unearthing — who or what will be reborn?

I experienced this intense excavation viscerally during my first Vipassana retreat in 2016. Ten days of silence, meditating from 4 in the morning until 8 in the evening with no other activity or interaction with the outside world. We were advised not to even make eye contact with other practitioners, lest it disturb the complete solitude of the mind.

It is perhaps one of the most extreme experiences one can undergo. I could not sleep for more than two hours a day during that first retreat. Every night I woke up screaming to recurring nightmares of dark corridors, drowning, faces I had not seen in years. My mind revolted, and turned my body against me with instructions of pain, in withdrawal from all the self-medicating substances I had been using for years to regulate my own mood. Where there once was an endless stream of information, tasks and human interaction — there was now only empty space. The mind could only grasp at that emptiness and race through its own inner maze, manic and hungry. Shining a light on seemingly forgotten memories. Plumbing the depths of its own twisted subconscious.

I remember despairing on the sixth day of that first Vipassana retreat. Every minute passed like a torturously slow murder. The physical pain only intensified, and my will weakened to rubble. I packed my bags, and sat outside the main retreat cabin.

“I’m not ready for this,” I said defensively to the instructor who appeared at the arched entrance to see me out. “I thought I was, but I’m not. Everyone else seems to be handling this well, but I’m really freaking out.” My own voice sounded strange to myself after such a long stretch of silence, disembodied and desperate.

The instructor looked at me with a blank expression. She did not speak for some time. And when she did — she simply said, “When a wound is healing, it will pain. All the impurities will rise to the surface. Your mind’s wounds are the same. At least here, you are being given some way to heal.”

In a way, the Covid-19 crisis has forced each and every one of us to undergo some form of excavation and unearthing — a mini Vipassana environment has been forced upon us. Across the world, we have /all/ been relegated to an uncanny and sudden state of solitude, confinement, standstill and silence. We have been given no tutorial, no proper interventions, on how to deal with the unique intensity of the moment.

As we deal with this new reality of isolation, more external pressures have been mounting, as economies collapse, livelihoods disappear, and loves ones around us fall ill or are lost. We do not know when it will end. Crucially, we have not been given any way to heal.

Instead, we retreat and watch the world outside through the mediation of screens, screens that are like endless reels of suffering. All we can do is wait, and try to survive.

I ended up finishing my Vipassana retreat - due to the empathy of the instructor, and knowing I was suffering in a safe space. Meditation was not comfortable, but it was a proper intervention, a way to reorder and rewire my mind. It has been singularly the most powerful intervention in my mental health journey to date.

In this past year - the entire world has been thrown into the tense discomfort of isolation, but how many of us had guides? How many of us had a proper mental map of what we were going through? How many of us were educated about the techniques and mechanisms of healing?

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How many casualties - beyond physical casualties, has this virus claimed?

Nearly 1 in 5 Covid survivors report significant mental distress post-recovery. Surviving family members of Covid casualties recount the absurd, Kafka-esque complications that impede even /grief/ — being forced to say goodbye to dying loved ones on video-chat, failing to congregate with family or perform usual funeral rites, the helpless return to isolation. In America, children as young as 7 are committing suicide after nearly a year of being kept from the usual routine of school and friends. In Japan, suicides outpaced Covid-related deaths in October.

At the time when we need mental health resources more than ever, the (sparse) resourced we have are being disrupted or rendered inaccessible; it is estimated that 67% of countries have experienced significant disruptions to counseling, psychotherapy, harm reduction and substance abuse services during the pandemic.

Last week, there was one particularly public casualty— Tony Hsieh, the celebrated chief visionary of Zappos, who died in a strange accidental house fire. All over the world, luminaries praised his empathy, vision, vibrant personality and beyond all — his public dedication to spreading happiness across the world. Until Forbes broke a story of the dark underbelly to that legacy, documenting Tony’s final year during Covid, where he grew increasingly erratic, isolated, descending into deeper substance abuse and disassociation from reality. His friend warned him of crossing the chasm from”eccentric to madness.” He was only 46 years old when he died.

Tony’s story was one catalyst that prompted me to pen these thoughts, and in doing so revisit my own journey of “mental health.” Indeed, too much of Tony’s “dark side” resonated with me — the immigrant experience torn between exile and belonging, the bifurcated identity between public ‘success’ (or in my case, at least ‘functionality’) and private despair. The race of the hyperactive mind to detach from reality, to self-medicate, to avoid excavation at all cost — to stall the unearthing of discontents we have unwittingly stored and hidden from ourselves.

And finally, this fusion of intense ambition and intense dysfunction, the deep intertwining of the two — until you cannot tell when one starts, and the other begins— until this unsettling duality becomes you, becomes you so deeply and completely that you are drowning. Consumed by contradiction.

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In “Invisible Men”, I wrote about how Covid is a dry run — an opportunity to expose the stressed systems and vulnerable structures that govern our economies and polities. Increasingly, I believe it is also an opportunity to expose and interrogate the vulnerability of the human mind in modernity — how we have ignored or de-prioritized mental health for far too long. How we have delayed much-needed personal excavations with endless stimulus, information, distraction. How we as a society have become sick yet lack the proper self-awareness to even begin intervention.

The WHO estimates that countries, on average, spend less than 2% of their budget on mental health. Outside of the developed world, mental health remains highly stigmatized, or worse — suspended in disbelief. It is time to fix those structures, to understand the universality of mental health as a part of the human condition.

Education, awareness and de-stigmatization are the necessary first steps to lead to effective intervention.

Forces against this necessary education exist— across cultural, familial and institutional structures. “If you talk about such problems, then they will become true,” was a common mantra of my Chinese parents. The interventions I needed in childhood were thus delayed, but thankfully not forever. I was the lucky beneficiary of so many accidental conditionals, I can barely began to count them.

If I had not been raised in one of the most developed nations in the world, if I had not had access to mental health education and resources beyond the influences of my family, if my college health insurance did not reduce my 3-year Upper East Side therapy bill from $300 per hour to $15 co-pay per session, if I had not stumbled upon and taken on Vipassana as a mindfulness practice, if I did not build the support system (family and friends) that saw me through those darkest years.

If, if, if, if. The razor’s edge is where so much of life is determined — and when I look back, the series of butterfly effects that separated the path between healing and death was thin, tenuous, and fragile. Whereas I fell on one side of the edge, too many (including friends whom I love and miss) have been lost on the other.

It should not be so.

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The journey of mental health fundamentally starts with awareness. Unfortunately, it does not start for everyone — but if the journey begins, it certainly never ends.

To this day, I am open with communicating about my mental health journey to colleagues, even acquaintances. I try to reference the topic candidly, not conspiratorially. I take leave citing simply a need for a ‘mental health day’, and am granted it without question — which speaks volumes about the character of my partners and colleagues. For those who become real friends, all are aware of the highlights of my entire history, though every year I note with some humor how my extreme past becomes increasingly “unbelievable” for those who are meeting me at this stable juncture of life. In a strange, almost poignant way, it has even become increasingly unbelievable to myself.

One reason I practice this radical honesty is to fight against stigma — to be ruthlessly vulnerable by example. Another is to remind myself that the journey never ends, and despite the recovery which enables me to live a normal, even high-functioning life viewed from the outside — my past will remain a defining part of “me”. So many of my decisions, and world-view, have been shaped by reckoning with despair — even death. It is a past I do not want to completely leave behind. And it is a past that, if ignored for too long, could manifest again.

When I was 19, two years into continuous therapy, I was diagnosed with borderline personality disorder. My therapist had waited so long, in her subtle and apt way, so I would not attach too much significance or self-pity to a ‘clinical diagnosis.’ Borderline is characterized by intense fear of abandonment, heightened emotional reactivity to nearly everything, highly unstable personal relationships and impulsive behavior that can range from extreme substance abuse to self-harm, from shoplifting to arson. It is a result of both genetics and certain developmental experiences.

Borderline, like most personality disorders, is a developmental condition. Studies show that symptoms peak in late adolescence and early adulthood; those who make it to their mid-20s typically experience a plateauing of destructive tendencies. For some — even complete recovery.

I will be turning 25 in January 2021. Seven years ago, making it to this age was a genuine uncertainty, and one of my only “North Star” goals. I used to think this was pathetic — to be someone who needs to exert so much energy just to ‘stay alive’, but now, it is probably the achievement I am proud of the most. There are few things more powerful than experiencing a truly new lease of life, and no better way to enjoy the multitude of pleasures and pains that our world has to offer.

This time around, on my 25th birthday — I will be celebrating not only survival, but hoping for a new world where experiences like mine can be the default, and not the exception.

Where mental health is an accepted and discussed part of our holistic well-being. Where the path from awareness to intervention to continued growth can be known and accessible to all.

I hope for a world where there are fewer and fewer people who fall on the other side of the razor’s edge. Those we have lost, and can only mourn or wonder:

What if?