Leading up to a severe mental health crisis, and at its apex, a patient hopefully becomes cocooned in intensive support: from a spouse, immediate family, perhaps close friends and a core team of medical professionals.
Those closest bear the brunt of the trauma. They’re usually the ones hiding the knives in the family home, ensuring a medication regime is adhered to, trying to minimise substance abuse and calling the police if things get out of hand.
This level of intervention is intense and challenging. As a patient, it can feel suffocating in its unwavering focus on keeping you alive. “Just give up on me!” You tell everybody. “Leave me alone.”
But our heavy reliance on the nuclear family means there’s an overlooked source of support that is chronically undervalued: the periphery.
The periphery are one or two or even three steps removed from the patient and may only have the barest idea of the turmoil they are in. But it is this – their distance and representation of normality – that makes them such powerful support people.
During one of my first crises, when I was in and out of inpatient care, regaining “normality” seemed impossible.
The ward psychologist suggested I contact one of my old English professors and ask to sit in on a class, for the mere sake of routine and distraction.
I shuffled to his office and without eye contact mumbled that I was unwell, newly manic-depressive, and could I sit in on a class please?
He immediately agreed, and I joined a crime fiction class. It helped enormously, giving me something to do during the days (read the course curriculum) and a taste of the ordinary, sitting in the lecture theatre surrounded by students my age, using my mind for something other than chaos.
My professor never acknowledged that I wasn’t a real student, not submitting essays or taking exams, and he never made any reference to my ill-health, beyond a benign “all OK?” occasionally.
The periphery are work colleagues who you’ve never hung out with as friends, but who call you every couple of weeks in hospital just to check how you are. They’re the beauty editor sending you a stack of magazines and self-care products even though you’ve never so much as had lunch together.
They’re the neighbour inviting you around for morning coffee a few times a week, as he knows you’re unwell and mostly have nothing to do. You barely speak in his living room, so he plays piano for you instead, and you feel some semblance of calm.
It’s also the ex-boyfriend visiting you on the locked ward, even though you split up when you were teenagers. Or the woman your brother’s dating, who you’ve never met, baking you a banana cake with vanilla frosting.
These people aren’t meant to matter in a crisis, it’s too complex for them, too knotty and too personal. They’re not close enough and they shouldn’t be involved – how embarrassing.
But actually, they really do matter. Family and spouse can feel oppressive when you’re very sick, and all the pleasure and closeness of those relationships becomes superseded by their quest for you to survive and recover. They go into hardcore “caring” mode, and it quashes any sense of being equals, or romantic partners, for a time anyway.
But the periphery aren’t directly responsible for whether you live or die, and it is this that gives them such great therapeutic power. The periphery can accept you as you are in the moment without trying to fix you, because that’s not their role. They can provide the warm cuddly stuff – the telephone calls, the gifts, the baking, the practical errands – and your relationship with them can remain largely unaltered by the current turmoil.
This might not apply for everyone, but I like nothing better than when someone who knows about my manic depression doesn’t mention it. And the periphery are so good at this – somehow able to express kindness and love without the burden of delving into the darkness of your illness.
Their job is to treat you like who you used to be, rather than the shell you currently are.
So often when we’re on the periphery of someone else’s crisis, we can feel paralysed by indecision. Shall I call the person, or is that intrusive? Should I send something or would that be over the top? They probably don’t want to see me anyway, we’re not that close.
We live in an age where boundaries are doggedly policed.
This saddens me, because tough boundaries don’t allow for the periphery to join in recovery. People can feel so wary of putting a foot wrong that they don’t make a move at all.
What I want to encourage is some opening up to the periphery and an appreciation of all the good they offer. They won’t save you, but they might just make you smile.
Taking that class made me remember my brain in better times. Listening to my neighbour play piano gave me a memory of joy and culture. And when I shared that beautiful banana cake on the ward, I was the heroine for a day, and all those very sick people were happy.
• Eleanor de Jong is the former New Zealand correspondent for the Guardian. She now lives and works in the Kimberley town of Derby, Western Australia
• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and ChildLine on 0800 1111. In the US, Mental Health America is available on 800-273-8255
