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Depression, the ‘Sickeningly Common Illness No One Likes Talking About’

Yet we must, as Anna Mehler Paperny’s brilliant, harrowing memoir instructs.

By Ian Gill 12 Aug 2019 | TheTyee.ca

Ian Gill, a Tyee contributing editor, is a journalist, filmmaker and social entrepreneur who founded Ecotrust Canada and was its CEO in the U.S. and Australia. Follow him on Twitter at @gillwave.

Anna Mehler Paperny is one tough little nut.

Okay, lest that sentence seem a little blunt, let me break it down.

Anna Mehler Paperny, as in the award-winning Toronto-based reporter for Reuters, former staff reporter for the Globe and Mail, and one-time reporter-editor for Global News, where she helped build its crusading online Investigative Data Desk.

One, because you can Google your guts out and you’ll only turn up a single Anna Mehler Paperny anywhere in the world: Toronto born, Vancouver raised, the eldest child of the celebrated Canadian documentary production team of David Paperny and Audrey Mehler.

Tough. Hold that thought.

Little. She’s pretty short.

Nut. Wiktionary provides 18 definitions for “nut” — everything from a fruit with a hard shell, to a testicle, to a poker hand. But it is the third definition on its list, the informal or slang meaning attributed to the word nut that concerns us here. Nut, as in “a crazy person.”

Sensitivity alert: in most quarters, it is considered offensive to use words like “nut” and “crazy” when referring to mental illness. If you are in that camp, it’s probably best that you don’t read on, and/or that you don’t share this story. In Anna’s fusillade against mental illness, and society’s inability to grapple with it effectively, she lays claim to language that’s often been used against people with mental illness. It is one of her sharpest weapons, or bluntest.

Anna describes herself at one point as “a crazy person housed in a modern-day loony bin.” Such is the tenor and tone of Anna’s writing throughout her wincingly direct, brutally frank, first-person account of depression and suicide, Hello I Want to Die Please Fix Me.

Hers is a harrowing journey into the heart of a “chronic, debilitating illness” that afflicts more than seven million North Americans who are “getting no lasting respite from any available treatment.” Harrowing, because Anna documents, in graphic detail, how her inability to find respite has led her to several serious attempts at killing herself — the last one earlier this year.

For Anna Mehler Paperny, the failure of modern society’s medical industrial complex to meaningfully confront, or in some cases even acknowledge that mental illness is one of the most urgent and pervasive medical crises in the world, feels like a punch in the face. So she decided to punch back.

“This illness is a systemic fuckup with an enormous impact,” she writes. To illustrate just how bad it is, she decided to make it personal. “Personal experience has made me more invested in addressing the gross inequities depression exacerbates, in hammering home the human, societal and economic costs.”

But in Hello I Want to Die Please Fix Me, “there is no happy ending. It’s an uncomfortably personal exploration of a sickeningly common illness no one likes talking about... in part because of our own squeamishness in confronting it or our own denial of its existence as an illness and the destruction it wreaks when left to its own devices.”

Anna’s chronicle is not for the faint of heart, and it is especially challenging for people who know her, who love her, who want her to be free of her disease, and are as angry as she is that there is no relief in sight. (Conflict alert: that includes me. I’ve known Anna since she was two years old.)

Anna’s story demands to be shared far and wide, because although her suffering is far from unique, there are few if any other people in the world who could mix such personal courage and reportorial doggedness with excruciating first-person experience, and pull off a high-wire act like Hello I Want To Die Please Fix Me.

‘We know Anna is a fighter’

It was Feb. 9 this year and I was asleep late one night in Tofino, on the west coast of Vancouver Island, when my phone vibrated. It was a message from Ric Young, husband of the Penguin Random House publisher Louise Dennys, both close friends. They were travelling in a remote region of Kenya with poor connectivity.

Ric wrote, “Louise received an email from David Paperny with the heading ‘Anna’ but has not been able to access the content. She’s terribly worried that something might be amiss. Do you know if all is okay?”

“I’ll check,” I replied, “stay tuned.”

(David Paperny and I are old friends. We met at The Journal back in the Barbara Frum era, 1989, and David took a job as a current affairs producer in CBC’s Vancouver television newsroom soon after. We ended up working together for years on documentaries, me on camera, David as field producer. Anna was almost three when they moved west. Our families grew up together and, not unusually, grew apart over time. I continued to work intermittently with Paperny Films.)

I called and texted David. At 3:49 a.m. Pacific time my phone buzzed. “Hey Jnr. (David’s nickname for me), I wanted Louise to know that Anna is in the hospital here in Toronto. She tried to kill herself a few days ago. She’s in bad shape. Unconscious. On dialysis.

“I don’t want to mess with her (Louise’s) holiday. Nothing she can do. We are obviously hopeful she can recover. But I didn’t know if random house (sic) was waiting for Anna to make any decisions, to submit something. Cuz she certainly won’t be doing anything like that at least for a while.”

Louise and Anna had been working for months on the manuscript for Hello I Want To Die Please Fix Me, and in her trademark fashion Louise became a fierce, loyal, demanding and utterly dedicated champion of Anna and her work. She had told me more than once that Anna had written a work of major importance that was going to save lives.

For a while it looked like Anna’s own life wasn’t going to be one of them.

She had ingested a handful of painkillers and a lot of anti-freeze and came within a whisker of dying. She was intubated for 12 days, in a coma for a week of that, intensive care for 19 days, and the staff at St. Joseph’s Health Centre told her parents that while Anna’s very survival was a miracle, her chances of recovery were slim. “We know Anna is a fighter,” David texted me at one point. “And she’s already come back from being nearly dead. Who said: Two steps forward one step back? Dorothy Livesay?”

David and I once did a short documentary about Livesay, and no David, what Livesay actually wrote in her poem Day and Night was this:

One step forward
Two steps back
Shove the lever,
Push it back

She might well have been writing about Anna’s journey through the health care system.

582px version of MehlerPapernyBook.jpg
Anna Mehler Paperny’s memoir unflinchingly recounts suicide attempts and living with depression, ‘a genuine and genuinely awful condition; we just don’t understand it.’ Photos: Random House.

Anna’s first attempt at suicide was in September 2011, ingesting a mixture of a handful of Zopiclone (sleeping pills) with a litre of anti-freeze. She was found alive in her apartment by Toronto police and paramedics who responded after being alerted by Globe editors when she didn’t respond to repeated calls from colleagues. Taken to St. Joseph’s, she gained entry into “a labyrinthine psychiatric care system via the trapdoor of botched self-obliteration.” She was 24 years old, working at the Globe, a dream job whose “reporter’s highs” from chasing and producing great stories were undercut by “lengthening episodes of despair during which all I wanted to do was die... The bilious taste of failure swallowed everything.”

Anna doesn’t blame anyone, except herself, for how she feels. “Every well-meaning therapeutic discussion I’ve had attempting to dredge childhood trauma proves futile and guilt-inducing. I’ve never been subject to anything awful enough to warrant this kind of mind-swallowing badness. I have a supportive, loving family, had a happy childhood. I’m a very fortunate person. Only problem is, I hate myself and want to die.”

Try as she might — eight attempts during the span of her book — Anna mercifully has failed to commit suicide, but in her punkish pursuit of good treatment, she has uncovered countless system failures in a field, mental health, that “gets one-third of the public funding cancer research gets, despite having, according to the World Health Organization, a higher burden of disease.” And that’s not allowing for evidence that suicides are under-reported “by as much as two-thirds,” Anna writes.

At St. Joe’s she enters an almost Orwellian system of patient controls — on 7M, the psych ward, Form 1 subjects you to a 72-hour hold and a psych assessment, Form 3 gets you committed against your will (if you have any) for two weeks in a latchless, off-white room, a rare escape from the pervading smell of stale urine being a caged-off balcony open a few minutes some days and offering a view of the Gardiner Expressway and Lake Ontario. Anna’s depiction of the psych ward, with an appropriate tip of the hat to Ken Kesey’s Cuckoo’s Nest, is convincing although not all that surprising. After “marinating in the guilt and self-disgust” of her suicide attempt long enough to convince her handlers that she wouldn’t try again, she’s discharged.

“Then you’re out and all the awful comes rushing back.” It was another year before the awful led her to have another go, or actually several goes. No luck smashing her apartment window and jumping 17 storeys; a month’s worth of lithium not enough before friends barged in and rescued her; asphyxiation attempts; rat poison bought but mercifully left untested; paint thinner. “Don’t try paint thinner,” Anna writes helpfully.

“I was abashed at how stereotypically girly all my attempts were: Women tend to go for poisoning... sometimes suffocation; men shoot themselves or hang themselves or jump from high places.” Every year, 800,000 people around the world succeed at killing themselves, Anna reports, one every 40 seconds.

‘Something to cling to’

What’s relieving about Hello I Want To Die Please Fix Me is that it isn’t just a solipsistic, scolding excoriation of a bad system written in barbed-wire prose (although it is occasionally that), but that about halfway through the eight years between her first suicide attempt and this, her first book, Anna decided to write the book, and then launched herself on her reporter’s journey.

She probes every angle, talks to every conceivable researcher, clinician, fellow sufferer, her parents, medical practitioners, front-line staff and academics and uncovers inequalities and inconsistencies and infuriations at every turn. She writes about the stigma of depression, the gender and racial and economic inequalities inherent in diagnoses and levels of care, about privacy, about ethics, coercive treatments, about how to talk about suicide and depression. Her preference is for “compassionate bluntness.”

She writes about treatments — cognitive behavioural therapy, neurotransmitter reuptake inhibitors, monoamine oxidase inhibitors, mood stabilizers, anticonvulsants, antipsychotics, psychotherapy, repetitive transcranial magnetic stimulation, electro-convulsive therapy, anterior cingulotomy (holes drilled in your head). In her case, 14 different drugs in dozens of combinations over the years, and “we haven’t yet found a combination that works.”

In large measure, she concludes, it is society’s failure to recognize depression as a real disease that denies its sufferers “compassionate, evidence-based care that would... alleviate the awfulness” they are trying to escape. “Depression is a genuine and genuinely awful condition; we just don’t understand it... And we’re nowhere close to breakthroughs in terms of how depression actually works.” So treatment mostly defaults to drugs, and unproven therapies that sometimes work and mostly don’t. Sufferers are left to mostly fend for themselves, clawing through a fog of contradictory advice and hit-and-miss treatments that would drive a person, well, crazy; drive a person to suicide, even.

“There are times when wanting your own death is not seen as pathological but as a rational decision, a choice to which you are entitled. It’s telling, though, that the kinds of pain North American society acknowledges as so unbearable as to make death an acceptable choice don’t include the pain caused by mental illness. In Canada and some U.S. states, a doctor can legally help you die if you have terminal cancer, but not if a mental illness is wrecking your life.

“Why does the pain of crazy people carry less weight than the pain of those who are not?”

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‘Brave, compassionate, insightful and wincingly self-aware.’ Paperny at a recent book launch. Photo via Random House.

Anna calls one day in early June. In a departure from journalistic convention, given the nature of the subject, I had asked David if he was comfortable with me personalizing my review of Anna’s book. He said sure, but maybe check with Anna. And here she is on the line, calling between sessions of electroconvulsive therapy because, while she managed to come back from the dead after her February relapse, and recovered to a degree that defied all predictions and her family’s most fervent hopes, sadly her demons weren’t magically slain in the bargain.

She is cheerful, wry, funny and self-deprecating. Classic Anna. Sure, she says, write about her how I want to, as long as I don’t start claiming any special insight into what got her to this place. Troubled youth, I saw it coming, any of that bullshit.

Deal.

But here’s the thing. Anna Mehler Paperny is one tough little nut. In parsing that opening line, I left out one word. It’s the word “is,” and maybe it’s the most important word of them all. Because Anna Mehler Paperny is with us still, despite her many attempts to not be.

And my goodness, the world needs more Anna Mehler Papernys, not fewer. Brave, compassionate, insightful and wincingly self-aware. Ready to challenge convention, hold feet to the fire, to “punch in the face with words,” as she puts it in her book.

At the end of Hello I Want To Die Please Fix Me, she writes that at times she’d felt worse than when she first tried to kill herself in 2011. But “work on this project (the book) gave me something to cling to and build on. It was validating. Almost every interview I did reinforced that this shit sandwich of an illness... affects many, many more people than me. Those were days that made it seem worth plugging away.” So she finished the book, and then tried to kill herself again.

In writing the book, Anna found that “suicidality and curiosity are anathema to each other: You can’t want to know things if you want to die. As long as I had questions I had reason to live, and when I was overwhelmed by a desire for death I could not begin to do the curious work that made life worth living.”

I love that idea, the curious work that makes life worth living. In writing Hello I Want To Die Please Fix Me, Anna has announced herself as one of the most tenaciously curious working journalists, working minds, that we have in this country. I can imagine any number of subjects worthy of the AMP treatment, although maybe not every societal ailment needs to be reported quite so vividly in the first person. Anyway, I for one am thankful for Anna’s first book. I can’t wait to read the next one.  [Tyee]

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