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The fall happens fast. One moment, I’m walking down the stairs; the next, I’m moving through space. I land to the sound of bone snapping.
I’m ridiculously lucky this has happened at the gym. Within minutes, a flurry of personal trainers is around me, helping me limp over to a weight bench and prop up my leg. The irony is rich that I’ve injured myself walking down the stairs, not doing some bionic box jump or high-speed treadmill run, which I don’t do anyway.
“I think you broke it,” one says, biceps bulging beneath his t-shirt.
“Definitely,” the other says, his face aglow with health.
Soon, my ankle is Gothically swollen. I call an Uber. They help to the door and navigate the slush outside and ease me into the car.
At Immediate Care, my ankle is x-rayed. The attending physician tells me my distal fibula is fractured. She puts the X-ray against the lightbox. It’s unmistakable: a piece of bone broken off in the blackness as if floating in space.
There’s no question the bone is broken. The diagnosis isn’t in doubt. We can see precisely that it’s the fibula, not the tibia.
In this, it’s so unlike the six mental health diagnoses I received over the past twenty-five years. No X-rays for those. No blood tests. Just doctors’ best guesses at how to define my bouts of depression, anxiety, confusion, exhaustion, obsessions, hyperactivity, compulsions, insomnia, panic, and suicidality (not all at once).
“The fibula isn’t a weight-bearing bone,” she says. “It supports and stabilizes. It keeps us steady. To heal, you need to immobilize your ankle.”
No doctor or mental health professional who leveled a psychiatric diagnosis ever mentioned healing.
Then it strikes me (slowly, dully) that I won’t be able to walk. “For how long?” I hear the panic in my voice. I’m already trying to heal from serious mental illness, and I’ve stopped taking Klonopin—just quit cold turkey, which is a terrible, terrible idea, as Dr. R will later inform me. The only relief from the constant hum in my chest is walking miles and miles—no matter how cold or snowy it is—as far as it takes.
“The orthopedic surgeon will give you a precise estimate for how long you’ll need to wear the boot,” she says, clearly not understanding the tragedy that’s just occurred.
“A week or so?” Even to me, what I’ve just asked sounds absurd.
“Um,” she draws out the word, “I’m going to guess it’s going to take longer than that.”
A nurse comes in with a huge, heavy, black orthopedic boot.
The physician’s tone is firm. “Don’t go walking around in it. When I say immobile, I mean immobile.”
“But I’ll be able to walk?” I ask as if she didn’t just say Don’t go walking around in it.
“The boot is support. A broken bone needs to remain stable. Otherwise, it won’t join or regrow properly. People try to push it, but that will just delay healing.”
I ask if I can walk a bit, just here and there, just—
“You can—if you don’t ever want to heal or walk again.” She opens the door to leave. “And keep it elevated even when you sleep. Maybe even sleep in the boot.”
People like to compare mental illnesses to physical illnesses. Type 2 diabetes is a favorite comparison. But the metaphor implies that psychiatric diagnoses like major depressive disorder and anxiety disorders and eating disorders and obsessive-compulsive disorder and attention deficit hyperactivity disorder are necessarily lifelong, which we know they aren’t.
One of the most valuable illness metaphors comes from Dr. Thomas Insel, a neuroscientist, psychiatrist, and the former director of the National Institute of Mental Health (NIMH). When I interviewed him years after I broke my foot, he likened mental illness to breaking a bone. As with a broken bone, we can heal from every type of psychiatric diagnosis, even schizophrenia, which is often treated like a death sentence. Healing is a long, complex process, he explained. When the bone first breaks, it bleeds. Then it becomes inflamed. Only then does it begin to repair. Finally, it starts to heal, which can take months or years, sometimes as long as a decade. What’s most remarkable is that after a bone heals, the point of the break becomes the strongest part. It’s as if we become stronger for having broken it.
Some people with mental illness take issue with the broken-bone comparison because they think it’s simplistic and dismissive. But breaking a bone is a big deal, and Tom Insel isn’t saying that everyone will heal from mental illness, only some.
It’s not a perfect metaphor in other respects. We don’t, of course, have the equivalent of an X-ray to show that someone actually has the psychiatric diagnosis they’re given. Approximate diagnoses and treatments are all we’ve got. It’s a lot to ask of psychiatrists: Heal me even though you don’t what exactly is wrong or have the remedy or cure. Plus, the bone is only the strongest part for a short time. After recovery, we don’t reach some sort of blissed-out state of high-functioning happiness.
As with mental health recovery, recovery from a broken bone will actually look different for each person. Some will heal relatively perfectly. They’ll run marathons and ultra-marathons, forgetting they ever broke a bone unless reminded. For others, the bone won’t quite set right, resulting in chronic pain or a limp for which they need continuous care.
Ultimately, no metaphor suffices. Mental illness is unlike any other experience or condition. It’s brutal and excruciating and can be fatal. But as with a broken bone, it can also result in full recovery.
The diabetes comparison might actually be the best after all. There’s early evidence that type 1 diabetes, once said to be lifelong (no exceptions), is, in fact, curable. In a recent study, one participant’s daily insulin use decreased by 91 percent, and—this is the miraculous part—his body started producing insulin on its own. It’s early yet and the study used a very small sample, but it seems that a once-incurable disease is curable after all.
Sleeping in the boot borders on Medieval. It’s like a very mild version of being on the rack. The boot weighs down my leg, stretching the ligaments no matter what position I sleep in.
For the next few nights, insomnia becomes my closest companion. Each morning, in front of my computer, drinking coffee, the ice I put on my ankle numbs the pain but brings with it an icy burn.
I’ve been feeling the blackness, the unsteadiness, the sodden pit in my stomach, the hum in my chest again. They’d lessened, which I’d seen as proof that I was, in fact, healing from mental illness.
The hum in my chest intensifies. The refrigerator drones. My thoughts race on repeat: I’ll never heal. My foot will never heal. My mind will never heal. My brain will never heal. My brain is broken.
Go to Chapter 19.