[Mis]Diagnosis: Crazy

Imagine being trapped inside your own body, your full potential locked away in incoherence. Like sheet music never played, or an idea never expressed. Okay, maybe I’m being overly poetic about it, but such is the case of a very close friend of mine. I’ll refer to her here as “Em”. We grew up together in Nigeria, and I’ve borne witness to her struggles throughout life.

As these things tend to go, the true nature and scale of her illness could scarcely be guessed at by those around. I casually call it an illness now, but it took years of observation for me to promote her condition from “just quirky” to full-blown sickness. I recently watched a documentary that examined many different mental health issues, everything from narcolepsy to PTSD. I’d never seen a case of Tourette Syndrome before then, and I was glad to become aware of it, considering the story I’m about to tell. I resolved to be even more patient, tolerant, and non-judgmental about things I simply do not understand. The film inspired me to write this post about my friend.

I’ll start my story from the very beginning – when we were wee lasses in Primary School. It was obvious at first glance that my new friend was lacking heavily in social skills. She walked and talked looking at the floor, didn’t speak unless spoken to, and couldn’t hold eye contact. Being a little girl, this was merely seen as cute by most people. What’s more “awww-inspiring” than a shy, smiley eight year old anyway?

On to Secondary School, but life here was not much different. It became clear that it wasn’t just her head she held low – her self-confidence level was also sub-par. Solving problems on the board, reading to the class, answering questions during a lecture – these were a source of immense discomfort to her. No one liked to do it anyway, but it was never a death sentence as it seemed to be, when Em was asked to. She told me how food crept up and sat in her throat, how her stomach filled with gas whenever she was put on the spot. This notwithstanding, she excelled in most subjects, although loathing the fame that came with it. Her circle of friends consisted of one – yours truly – until a couple other students clawed their way over and under her high wall of solitude. Drama, music, sports, or any other form of social activity could not be stomached because of the massive problem of stage fright, so it was hell on earth for her when we were forced to participate in one of these every week. Any activity that required her having an audience of any sort was disliked and shunned. She somehow always managed to scale through with many bogus claims of ill health, personal assignments from teachers or “being swamped with other social activities”. I witnessed all of this and even I thought it was temporary, something that would simply fade away the older she got. I was hugely mistaken.

Things got much worse during the experience that was University. Having gone to an all-girls secondary school, suddenly being in the presence of thousands of boys was a lot to handle. Em’s former symptoms persisted, even as much more evolved. Her self-conscious meter increased drastically, then exploded altogether. She lost weight, as she could not put food down prior to facing each day, and would frequently go without breakfast and lunch until she was done with classes. Bruxism, trembling hands and excessive sweating prevailed. She was nervous about almost everything, but had started learning to hide it impressively. In fact, not many people would describe my friend the way I am, because most people didn’t know. They could easily chalk off the sweating to our tropical heat, the weight loss to the rigours of school work. She studied herself a great deal and learned that the more nervous you looked to people, the more attention you attracted. And so she made a conscious effort to curb the feet-shuffling, pen-twirling, finger-tapping tics that could give her away. It was difficult, as these were her outlets for nervous expression. Take them away and you’re left with a shaken Coke can with no escape vent. It was indeed counter-productive. I once went to see her make a presentation and a phenomenal thing occurred. While sitting together and waiting her turn, I watched her develop a fever and become physically ill with nervousness. By the time her name was called and she shuffled up to face the room, a grey pallor had overtaken her face, and her lips were white with dehydration. The first fifteen seconds consisted a horrible, endless and deafening silence during which, she later confessed, she’d forgotten the reason she was poised in front of that crowd. Her fingers shook so badly, another student helped her switch slides. Halfway into the talk, she was stopped by one of the lecturers, who said that her work seemed good enough and he was impressed by her “calm and eloquent delivery”, but she was obviously ill and so could end the presentation at that point. I knew my friend had issues, but only then did I realize just how bad they were.

I could give a million instances of such epic displays of nerves, but I’ll fast forward to the present. With age comes wisdom, and my pal has so managed her social ineptitude that as of today, no one except for myself can guess the magnitude of her aversion to social interactions. As she got older and the problems persisted, she realized she had to “fake” her way through life, as there was no tolerance for odd or otherwise quirky people in the world of adults, more so in my country. Here, the idea of therapy or psychological evaluation is as alien as the little purple guys with squinty eyes. You will find no help with diagnosis, let alone treatment of any ailment that is not purely physical. In fact, we have just one abandoned building for a “psychiatric hospital” in a state with six million residents! Such things are seen as “white people problems”, and anyone afflicted with anything remotely regarding ill-health of the mind – from PTSD to psychosis – is tagged “mad” and is doomed to wander the streets, endlessly indulging their mania. In a place where cancer can be misdiagnosed as malaria, social anxiety is downright entertainment.

My friend’s issues have multiplied, even as her strategies for dealing with them have evolved. It’s a brutally competitive world now, and especially with the current economic state of affairs, employers have zero tolerance for staff that cannot deliver. Em is exceedingly good at her job and has risen to an impressive level in her career, but meetings and presentations which are a staple in most businesses, are threatening to undo her. Getting through a small meeting of three is a herculean task for her, let alone an international conference involving tens of clients – even when online or over the phone. So now instead of just bottling up her nervous ticks in such situations, she replaces them with seemingly bold and decidedly not nervous-looking actions in order not to stick out passively as the quiet one in the room: taking front-row seats as opposed to hiding out back; piping up with questions required or not; adopting the body language of decidedly calm folk; making suggestions out loud instead of whispering to someone close by. But these little triumphs are merely superficial. Afterwards she rushes to the ladies’ to deal with the effects: acid indigestion, flatulence, excessive sweating, and what feels like a stomach ulcer but is presently undiagnosed. Even in her bed, sleep troubles arise at the thought of facing the next day. So much so that she is considering leaving her job altogether.

So after much extensive research, Em and I have come up with our own diagnosis of her problems. Social Anxiety Disorder (obvious enough), Obsessive Compulsive Disorder (I chose not to disclose some compulsive behaviors she exhibits), and depression (resulting from her many struggles at work and issues at home) to name a few. Whether these are distinct ailments or symptoms of each other, are details best left to a professional. And therein lies the problem.

I am now very afraid for Em. Her mental health continues to deteriorate (perhaps because she is now perpetually immersed in a lifestyle she so detests), which in turn continues to have physical manifestations that are wreaking havoc on her body. Her personal, social and work life are a mess. We live in a corner of the world that does not yet acknowledge the authenticity of psychological disorders, whereas the more scientifically advanced world recognizes ADHD, dyslexia, schizophrenia and other mental health problems as fairly common now. Doctors prescribe Prozac and Zoloft everyday and the quality of people’s lives is greatly improved. Yet most suffer in silence and misconstruction.

I see Em and know she can’t truly live her life to its full potential – there would always be something in her way: herself. A thought not properly expressed to someone, a moment not fully enjoyed, and of course, those ever-present cloaks of self-consciousness and self-doubt. There is a misery and a loneliness which cannot be penetrated, simply because no one understands or even recognizes the personal problems she constantly battles with.

I forget my initial purpose of writing this post. Maybe I just needed to write something down and it was topmost on my mind. Maybe to provide a little insight and clarity on Em’s woes, for posterity’s sake. Perhaps to broaden the mind of anyone who happens to read this to be more accommodating and less judgmental of people in general, because many disabilities are not immediately apparent. Some people are like the pretty ducks we see in ponds – seemingly calm and picture-perfect on top, but toiling tirelessly underneath to keep up the appearance.

And through it all, Em wears a brave face and smiles at life. My girlfriend knows that in the grand scheme of things, all of her worries are actually a non-issue. She says there are parents watching their children starve to death, people battling stage 4 cancer, and some others missing critical body parts. Most days, that knowledge helps keep her going. Yet I know her struggles are threatening to devour her because through it all, I am at her side. I watch, helpless as she suffers.

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