How Our Environment Affects Us

When I say environment here, I don't mean the planet or anything ecological. I mean the environment that surrounds each of us personally: the people in our lives, the situations we find ourselves in, the conditions we wake up to every day. Someday I'd like to write about how the physical world around us plays into mental illness too, because I find that question genuinely interesting, though I haven't read much on it yet. For now, let me stick with the people-and-circumstances version of the question.

Start with me. I grew up in the care system. There was abuse, and then the long adjustment to an adoptive family. When I was born I weighed barely three pounds and was very sick, partly because of lithium in my mother's blood. More trauma came later, through abuse in elementary school and again as an adult. Life after the adoption was reasonably stable, but bipolar disorder arrived quietly, right at the age when my worst decisions passed for the ordinary dumb things young adults do. That camouflage is the trap.

What my bipolar actually did was build an environment around me that slowly turned toxic, and nobody caught it. Not me, not my family, not my friends. That is the cruelty of mental illness: it slips in without announcing itself and then detonates. Think of a cold that feels like any other cold until, out of nowhere, your life is at stake.

So does the environment around us shape whether we recover? I'd say clearly yes. There is a ceiling on what any one person can manage alone. Working with people these past few months, I've seen how much stress traces back to family. That's common enough. But turn it over: what happens when your family carries its own mental illness? What if suicide has touched you while you were already fighting your own battles? Sometimes relatives simply can't understand you. Sometimes they put you out of the house, and suddenly you're alone. People lose friends, partners, whole families, because the conditions around them never spelled anything close to success.

Here is the part that's hard to sit with. The environment isn't a one-way street. It may be harsh, but it's harsh partly because of what we put into it, which also means we have a hand in rebuilding it.

Let me walk through a situation, a made-up one, that still describes a lot of real lives. Picture a boy abused in childhood. He's traumatized, and on top of that he may be developing PTSD and bipolar disorder, none of it diagnosed as he moves through elementary and middle school. In those years he acts out: punching classmates, screaming at teachers, racking up suspensions. By high school the symptoms are stacking higher. In his senior year he has a massive psychotic break and doesn't seek help, because he has no framework for what's happening to him. He's drinking and using drugs, a self-medication routine that seems to work as long as he gives his life over to it.

Then he gets aggressive and gets arrested. Then arrested again. After enough of this, his family puts him on the street and tells him to get help. By now he has lost any sense of who he is, and he hasn't had one since he was small. The early abuse pulled him off a path that could have been fairly ordinary and livable. The illness keeps hounding him. Eventually he's given medication and refuses it, because of how it makes him feel. Off the medication the hallucinations come, his thoughts scatter, he drifts into another world, and he slides toward suicide. Voices tell him to kill himself, and he has no idea what to do with that.

Plenty of young adults and older adults have lived some slice of that invented story. Do you see how nearly impossible it is to climb out of these conditions on your own? When you're young, and I mean especially when you're young, you need someone to say plainly: go see a doctor, get on medication. If abuse is in the mix, that's extra trauma standing between you and an accurate diagnosis.

My position is that we should pay attention to our environment and also shoulder some of the responsibility for seeking help. And at the same time, there's a harder question underneath it: how do we build conditions good enough that a person can confide in a relative, lean on a real friend, or walk into a doctor's office without feeling their whole life hangs on whichever way they turn?

What I've learned for myself is that I needed help up to a point, and past that point the difference was mine to make. The environment works the way everyone around us works: it either nudges us forward or drags us back. We have to find some workable middle ground. And society still has a long way to go before it steps up to the plate.

- Susan Page