There is research evidence that physical, social, environmental and psychological factors can contribute to the development of severe distress that gets diagnosed as mental illness. For most people, their mental health problems result from many factors interacting with each other. This is similar to the way that physical health problems often develop. Frequently it is difficult to pinpoint one main cause. For example, the link between a person’s genetic make-up and mental health is complex, and not well understood.
The people we spoke to had received various psychiatric diagnoses at different life stages. Most people could not identify any special reason for becoming unwell. Many found it hard to attribute first starting to feel unwell to particular circumstances or events. For some, feeling unwell began after the culmination of many things. As Helen said, ‘certain things that have happened through my life have maybe, all combined, pushed me into depression’. While many people were first diagnosed with severe mental health problems in adulthood, some described themselves as being ‘different’ and experiencing anxiety or other problems from an early age. For Ann this was as early as the age of two. This fits with strong research evidence that most people who experience severe mental health problems as adults first have similar experiences as teenagers or young adults, even though they may not receive a diagnosis at that stage of life. Tanai said her mother had a virus during pregnancy, and that people thought Tanai experienced brain damage in utero which effected her mental health.
While some people did experience life events that were out of the ordinary or ‘traumatic’, these were not always identified as contributing directly to mental health problems. Rather, some people talked about such life events as difficult times that they had to deal with, occasionally in the context of an existing diagnosis of a severe mental health problem (see Negotiating daily life). For other people, it was the way they responded to these unusual or distressing events that alerted them or others to the fact they were unwell.
Nonetheless, many people spoke about the time when they first became unwell as being a time of particular pressure or stress in their lives which was often attributed to work, studies, relationships or parental pressure. Carlo was in a high powered job in the city when he experienced panic attacks and heart problems. Maria found the pressure from her parents to be ‘more Greek than Australian… reached boiling point’ when she was diagnosed with bipolar disorder at the age of 19. David experienced ‘a personal loss’ when his best friend died in a car accident and someone he was ‘in love with’ was dying of cancer at the same time. He was told he had post-traumatic stress.
Ann was sleeping a lot towards the end of her studies, and had moments of wishing her life ‘would end’. When she got a job she was bullied at work, which she said was ‘when things really went quite pear-shaped’.
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I moved to [city] and everything sort of seemed really rosy for a few years. I met a man who I spent almost 14 years with and married him and we had a great relationship for a lot of years. And I had good jobs, and I went back to university and got a degree and did my honours. And things were pretty good. I mean I’d still have moments where I wouldn’t feel suicidal but I’d wish that I’d have a car accident, or I’d wish that I had cancer or something so that my life would end but not by my own hand.
But I never told him that and – I just never told him. But I was sleeping a lot towards the end of my studies which is a sign for getting depressed for me. But we both sort of dismissed it and carried on as normal and then once I’d finished up at uni I got a job and was getting bullied in the workplace. And that’s when things really went quite pear-shaped, so I ended up having to take time out on stress leave.
Moving house was a time of stress for some. Vanessa moved to the city from a small community where she lived on a farm. The transition from a place where everyone was ‘warm’ to a city where people were ‘not very hospitable’ created a lot of stress and eventually she experienced ‘major depression’.
Brendan noticed the first signs of depression when he moved to a new state with his mother and stepfather when he was 15. He missed his brother, found it difficult to make friends, and felt isolated.
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I think for me, I really started to – not that I ever knew that there was anything particularly wrong, but I’ve been asked before, when I first thought, maybe that I’d noticed signs of depression and I think for me it went back to when I was around 15 years of age. I’d recently moved from [state] to [state] with my mum and my stepfather and my brother. I’ve got an older sister but she stayed in [city] because she was at uni.
And so I moved from one high school to a new state, and I moved to two schools in the [state], in the space of about three months. In that time my brother, who I was very close to then, and still am now, moved back to [state]. So I found myself in a new state, another new school. I guess not, having always lived with my brother and sister, not having them there and I’ve got an uncle who was in [state], but there was no other family, apart from my mum.
So I think I felt really isolated, and that and the new school, being new, and being that it was in year ten, I think by that stage people tend to have developed relationships. And so I found it very difficult to make friends and found that I wasn’t really going to school a lot.
When
Helen’s husband put pressure on her to move to his homeland, she found she had trouble sleeping. After the move, she said, she ‘started to get out of hand’.
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So how long ago was this, Helen?
Oh, well that would have been back in, we went to [country] in 1989 – I’d say about 1987 probably. That would have been my first experience with depression then.
And could you tell me a little bit about what you were experiencing to go to the doctor in the first place?
Well, I went to the doctor and I was – my GP and I, we have a good relationship, you know. I could speak freely and easily with him and that. And because I had the three kids and had the pressure of [my ex-husband] trying to get me to go over – back home to Europe – to live and that.
He was [nationality]?
Yes, having that pressure, you know, trying to make that decision, and that’s where I was becoming anxious. And no one ever noticed because it happened at night time mostly and my husband was working night shift at the time. But I just couldn’t sleep at all. I was up vomiting and I just carried on during the day as if nothing happened. But then it just got the better of me and I was just a total wreck. And my sister came round to visit me and she said, “What’s wrong with you?” And I said, “Oh, I don’t know, I’m just not sleeping and that.” She goes, “Go to the doctor’s”.
And then I got through it. I don’t know, I can’t remember exactly what period of time I was in that depression then, because I wasn’t, I didn’t really feel like I was depressed. I thought I was just on a downer because of the pressure of having to make that decision to leave Australia to go live in a country that I didn’t want to live in. And so I just got back into the swing of, you know, my daily life and just kept myself occupied and finally made the decision to say, “Yes, I’ll give it a try”. And we put the house on the market and we moved.
And leaving Australia was one big step. Leaving my family, you know, because Mum and Dad were at an age where they weren’t getting any younger. They were getting older. Mum had her health problems and that, and it was hard. And then once we moved to [country], then I was really getting out of hand. I think that’s where it really basically started. You know, not sleeping at night time. I used to wake up in the middle of the night, get into my car and I’d just drive north, south, east and west of the island.
Young adulthood could be a particular time of pressure and stress (you can read more about that here: Childhood and adolescence)
Luana became ‘really stressed out’ when a lecturer told the students that 70% of them would fail. Later, the stress of doing well at work led to a breakdown.
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I first developed a mental illness at the age of 24. I was studying a double degree at [university] and I found that I was getting really stressed out by a lecturer who told me that, I think, it was about 70 per cent of students who do the class fail. So I became quite obsessed with that figure of 70 per cent and I couldn’t really keep my thoughts coherent.
All I could think about was just failing the subject. And unfortunately that obsession led to extreme stress leading up to exams and I ended up failing about four units of study due to the stress of my mental health. So, but I didn’t realise how bad it was at the time. I ended up just taking an absence of leave and taking six months off and having a rest and break and I was lucky enough to sort of become well again after that break from study.
So I went back and finished my course and then from there I eventually ended up working in the public service and I worked in the public service for four years in a couple of different departments. And then unfortunately I was sent away to [island] for work and I had the same thing happen. I was told I wasn’t performing well enough in the job on [island]. It was just a short term project and unfortunately because it was from someone quite senior I became obsessed with what I was told and I couldn’t think coherently and I became really stressed there and I was drinking and not looking after my health.
And I thought when I went back to [city] that things would become better but unfortunately they didn’t. I was still quite sick and I couldn’t relax and I was stressed out because I was worried that what I’d been told on [island] would follow me to my job back in [city]. And unfortunately eventually just the stress of everything got to me and I ended up having a complete breakdown.
For
Sarah, her early 20s were ‘a confusing age’. She was just out of school and still working things out when she went on a Buddhist retreat in South East Asia and began hallucinating.
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And so when you thought about going to [country] and [country] to find yourself, what were you hoping to get out of it at that time? Do you remember?
Well, I think that I, just to get a sense of understanding about – I didn’t know who I was. It was a confusing age. And I was possibly even mentally younger than what I was because of like the drugs and things like that. But I think that yeah, it’s, I think it’s a lot to do with the age. You don’t know who you are. You don’t know what the world’s about or where you stand in the world.
Everything’s kind of fragile and changing and you’re just about to hit your – well, at 22 [rather] than being who I was or… You know, you’re out of school and you’re sort of still working every – I was still working things out at that time. So I didn’t know what to do with myself and I didn’t know what was right.
Well, I actually became unwell while I was overseas. I took a trip to South East Asia to find myself. And I ended up at a Buddhist Monastery in [country] and I stayed there and did a one month meditation retreat and…
And I walked out of the doors and basically just completely broke down and then everything, the culture shock and everything to do with that just everything about the trip just sort of became way more intense. And I was just lost in [country] and my mum came and got me and no-one knew what was wrong with me for a while. I wasn’t eating and drinking and so at the beginning people thought I had an eating disorder. But yeah the reason for that was more to do with thinking that I was sort of getting commanded by like a Buddhist llama, that I thought I’d made a connection with. Yeah, it sort of was giving me orders or something. Anyway, so I ended up in a private hospital and then I ended up involuntary.
Some people were distressed by experiencing vague and shifting mental health problems over long periods of time. This is a typical situation for young people with mental health problems who may or may not receive a psychiatric diagnosis later in life. A few people described how they had taken recreational drugs at some point in their lives. Some said this had helped them to cope with stress or anxiety, but others felt that it may have contributed to their distress.
Dealing with pain, physical illness, injuries or disabilities, was a critical time for some people (see Physical health and mental wellbeing). Bernadette said she ‘slipped into a psychosis’ when she was being treated for hepatitis C. She described this as the side effect of medication combined with ‘a whole lot of stressful stuff that happened to me while I was on it’. Cindy described how she ‘suffered depression’ after seeking medical help for a painful skin condition that resulted in ‘itchy burning sores on her hand’. She described becoming ‘worn out’ because doctors ‘weren’t listening’ and ‘didn’t want to believe’ her. One doctor told her she was ‘delusional’. Her skin problem was never resolved.
After
Michelle had an operation for sciatica the pain returned and the doctors couldn’t find a cause. She said the pain was ‘slowly eating away at’ her mind.
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And so I got the back operation and it worked and I was pain free, you know, straight afterwards. It went all right for about two years and then the pain returned and yeah, it was really horrible. But this time I didn’t get the sciatica, it was just really horrible back pain, sharp back pain and this time around because the scans and things showed that it wasn’t interfering with nerves no one wanted to do an operation on it or anything.
And so I was going through this process of being in a lot of pain and seeing all these different neurosurgeons and feeling like no-one wanted to help me. But the fact of the matter was that the operation, a fusion, probably wasn’t going to help with the back pain anyway.
So I was trying to cope with the back pain for quite a while without being properly managed for the pain because GPs don’t really like to – well my GP didn’t really want to give out anything too strong and it’s very hard for people to gauge how much pain someone’s in. I guess.
But the pain was slowly eating away at my mind and I think that being undermanaged for my pain was what was a big part of bringing on what triggered the illness – the schizophrenia.
Although
David had experienced ‘mental health symptoms on and off’ from his pre-teens, he had never sought help. When he had surgery that left him with chronic pain he felt suicidal and asked to see a psychiatrist.
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Yeah I guess, I had, I definitely had mental health symptoms in my early teens, early even before sort of pre-teens and I was too intimidated to seek help. And the problems remained off and on for many years. It was only after I had a major physical procedure, a surgery and was left in constant pain afterwards that I sought help with coping because my GP had identified that chronic pain obviously has an impact on mental health and mental health came back on the experience of pain.
So that sort of led me down that path in terms of making sure that I was taking the best care of myself as I could. And I actually, you know, it took me another two years, two more years of just trying to – I was on I guess, on a basic anti-depressant trying to just… I think I had a little bit of depression. I wasn’t too bad but I was trying to cope with the pain. I did a major injury at work and ended up having a big argument with WorkCover and I started losing touch with reality and sought a referral to a psychiatrist. That wasn’t available for a period of time even though I was in crisis.
So I reached out to services, [mental health organisation], and what else? There was a local community mental service that did some emergency counselling in the interim. I thought that I definitely needed some professional help in terms of coping because I was suicidal and didn’t really know how to cope with things I was processing.