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đ§ Listen to Sarah read this installment of Cured:
The fall happens fast. One moment, Iâm walking down the stairs; the next, Iâm moving through space. I land to the sound of bone snapping.
Iâm 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 Iâve injured myself walking down the stairs, not doing some bionic box jump or high-speed treadmill run, which I donât do anyway.
âI think you broke it,â one says, biceps bulging beneath his t-shirt.
âDefinitely,â 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. Itâs unmistakable: a piece of bone broken off in the blackness as if floating in space.
Thereâs no question the bone is broken. The diagnosis isnât in doubt. We can see precisely that itâs the fibula, not the tibia.
In this, itâs so unlike the six mental health diagnoses I received over the past twenty-five years. No X-rays for those. No blood tests. Just doctorsâ best guesses at how to define my bouts of depression, anxiety, confusion, exhaustion, obsessions, hyperactivity, compulsions, insomnia, panic, and suicidality (not all at once).
âThe fibula isnât a weight-bearing bone,â she says. âIt supports and stabilizes. It keeps us steady. To heal, you need to immobilize your ankle.â
No doctor or mental health professional who leveled a psychiatric diagnosis ever mentioned healing.
Then it strikes me (slowly, dully) that I wonât be able to walk. âFor how long?â I hear the panic in my voice. Iâm already trying to heal from serious mental illness, and Iâve stopped taking Klonopinâjust 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 milesâno matter how cold or snowy it isâas far as it takes.
âThe orthopedic surgeon will give you a precise estimate for how long youâll need to wear the boot,â she says, clearly not understanding the tragedy thatâs just occurred.
âA week or so?â Even to me, what Iâve just asked sounds absurd.
âUm,â she draws out the word, âIâm going to guess itâs going to take longer than that.â
A nurse comes in with a huge, heavy, black orthopedic boot.
The physicianâs tone is firm. âDonât go walking around in it. When I say immobile, I mean immobile.â
âBut Iâll be able to walk?â I ask as if she didnât just say Donât go walking around in it.
âThe boot is support. A broken bone needs to remain stable. Otherwise, it wonât join or regrow properly. People try to push it, but that will just delay healing.â
I ask if I can walk a bit, just here and there, justâ
âYou canâif you donât ever want to heal or walk again.â She opens the door to leave. âAnd keep it elevated even when you sleep. Maybe even sleep in the boot.â
*
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 arenât.
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. Whatâs most remarkable is that after a bone heals, the point of the break becomes the strongest part. Itâs as if we become stronger for having broken it.
Some people with mental illness take issue with the broken-bone comparison because they think itâs simplistic and dismissive. But breaking a bone is a big deal, and Tom Insel isnât saying that everyone will heal from mental illness, only some.
Itâs not a perfect metaphor in other respects. We donât, of course, have the equivalent of an X-ray to show that someone actually has the psychiatric diagnosis theyâre given. Approximate diagnoses and treatments are all weâve got. Itâs a lot to ask of psychiatrists: Heal me even though you donât 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 donât 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. Theyâll run marathons and ultra-marathons, forgetting they ever broke a bone unless reminded. For others, the bone wonât 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. Itâs 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. Thereâs early evidence that type 1 diabetes, once said to be lifelong (no exceptions), is, in fact, curable. In a recent study, one participantâs daily insulin use decreased by 91 percent, andâthis is the miraculous partâhis body started producing insulin on its own. Itâs 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. Itâs 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.
Iâve been feeling the blackness, the unsteadiness, the sodden pit in my stomach, the hum in my chest again. Theyâd lessened, which Iâd 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: Iâll 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.