Emma's mental health journey has left her stronger and more capable

Watch Emma talk about mental health journey

“I live with both bipolar disorder and a disorder of the hypothalamic-pituitary-adrenal axis,” says 39-year-old Emma Attwell. “After both diagnoses, it took me a long time to realise I still had a life ahead of me. It took even longer for me to make a conscious decision to pursue that life to the full.”

“A friend of mine who suffers from mental health problems, and who had also gone through cancer, once said to me, ‘We need to be vigilant and militant about our health!’. That hit home because I know that there is so much misinformation around mental health issues that one becomes afraid to seek medical help. I am fortunate enough to have worked with doctors who have taken my symptoms seriously but who also had insight into how a depressive episode or heightened anxiety might be contributing to physical ailments. I am also very fortunate to have a psychiatrist who sees me holistically, notes physiological versus psychiatric symptoms and reminds me that I am more than the sum of my diagnoses, famously ending the bleakest consultation with ‘There is hope, there is always hope’.

Emma’s first suicide attempt at age 12

Emma’s early years were particularly difficult, with numerous challenges arising from moving cities frequently and having a pervasive feeling of alienation from her peers and even her family. “I started to show signs of depression early on. Though nothing specific drove it, socially I felt like I didn’t fit. I didn’t finish my last year of nursery school because, at the age of five, I was so unhappy I insisted I would not go back to school. At home, my mom taught me to read and I went everywhere with her,” she explains.

Emma was bullied throughout primary school. “Children know who is vulnerable and will always pick on that person. After two and a half years of intense shaming by my peers, at age 12, I carried out my first suicide attempt. I went to the garage to look for bottles with poison signs on them, found paint remover and drank a little, went to sleep and woke up crying that I was still alive,” she says.

In her high-school years, desperate to fit in, she developed both bulimia and anorexia. “I felt unhappy with my body and felt a need for control. The eating disorder was a manifestation of these feelings,” she explains. “The dreadful thing about an eating disorder is that it consumes you, but it’s also a way of coping with emotions that you’re incapable of self-soothing – a skill I’ve had to learn with the help of a very dedicated psychotherapist.”

Emma’s eating disorders worsen at university

After a time spent at Tara Psychiatric Hospital in Johannesburg when she was 16 years old, and with the help of a psychologist and a caring teacher, Emma went to Rhodes University in the Eastern Cape, where she started a Bachelor of Arts degree in English and psychology. But, her eating disorders persisted. She weighed 40 kg at the time.

Says Emma: “At university, my competitive nature pushed me to breaking point. I was obsessed with being at the top of my class and terrified of not getting into honours and master’s degree courses. In parallel, bulimia became a way of life for me. Eventually, my friends found out and it was humiliating. I had no way to explain what I was doing or to stop the chaotic and damaging behaviour. At 21 years old, halfway through third year, I was getting Dean’s Merit List marks and already had Academic Half Colours but, emotionally, I couldn’t take another step. I felt I was a lost cause – a fish always swimming upstream.”

Professional intervention sees Emma begin the road to recovery

Emma had, by that stage, overdosed on paracetamol a few times. Eventually, after a few days at the university sick bay, the university’s psychologist told her parents to come and fetch her. They checked her in at the Akeso Kenilworth Clinic – a psychiatric hospital in Cape Town. Finally, she started to see a turnaround, while on a six-week eating disorder programme.

“I had been prescribed antidepressants by GPs before, but this was the first time that I saw a psychiatrist. He was exceptionally kind and I connected with him, for the first time feeling like I could really open up. He said to me, 'I don’t think you’re a lost cause.’ That really stood out for me,” says Emma. She also saw a dietitian, who helped her normalise her destructive eating habits.

“The first two weeks I was very resistant to the programme. I didn’t want to eat. I didn’t want to gain weight. I threw tantrums and kept insisting I wanted to be dead. Eventually the psychologist who led the programme told me in a group session, ‘You need to decide if you are going to live or die because in this programme we deal with life, not death.’ I committed to recovery. When you have an eating disorder, life is black and white – you can have this and not that and there are no shades of grey or room for error. I slowly learnt to normalise healthy eating and my weight stabilised at 54 kg. I was finally okay with how I looked.”

Emma continued to see her dietitian for three years after her discharge.

Emma finds Hope and Grace, and becomes a mom

At the age of 21, Emma volunteered at the Red Cross War Memorial Children’s Hospital. There, she met a little girl who made such an impression on her that Emma set her heart on adopting the child. Two years after bringing Hope home, Emma met a second little girl, Grace, who captured her heart. At 24, Emma was a single mother to two little girls who became – and remain – the focus of her energy and love.

Hope is now (in 2019) 19 years old and has been in Emma’s care for 16 years. Emma’s second daughter, Grace, is 14 and has been in Emma’s care for 13 years. Emma explains her remarkable decision to adopt them, when she herself was barely out of her teen years. “These little girls came from trying socio-economic circumstances and had traumatic starts to their lives, yet I knew that I could give them a loving home. Together, we are a strong family unit. Some people saw my decision to adopt as a manic manifestation of my mental health issues. My parents saw something else: they saw their daughter find hope and purpose in these little children, and they stood by me. They unlocked a part of me that is whole and true, something I had never known in myself.”

Life as a single mother to two adopted daughters has not been without its challenges. “My girls are strong young women who have thrived against all odds. Both have quite severe developmental disabilities,” says Emma. Hope has an autoimmune condition and Grace has autism and epilepsy. Both suffered early deprivation and failure to thrive. “I didn’t plan on things being this way. Who would? But, I am strangely grateful for our journey. I look at my children and I think, ‘I wouldn’t have them any other way.’ They are my perfect in my eyes,” says Emma.

She knows the importance of forming a strong therapeutic alliance with healthcare professionals and has seen the same psychologist for several years. “My psychologist has been a rock in my life. I initially went to see her when Grace was diagnosed with autism, as I was devastated, but over the years, therapy has been about so much more. The biggest impact has been in developing the ability to self-soothe, to have compassion for myself, and to look at the bigger picture and appreciate what I am doing – things I could not even contemplate when I was in my twenties. She really has given me the tools and strength to cope going forward.”

Mental illness and the workplace

Emma went on to finish her degree in 2006 and pursued a career in educational publishing. Her depression and anxiety persisted throughout. “I found office jobs incredibly difficult as I had to keep up a façade all day long. That requires an enormous amount of energy, as you are not just trying to prove yourself at work, but you are also trying to prove that you are more than your diagnosis. I would get home every day and crash. I was working way harder for longer, to do way more than was necessary, and prove that I was more than a ‘mental patient’.

In most environments, and with time, people were accepting, but usually only my immediate manager knew what was happening to me. My illnesses, in combination with perfectionism and a strong work ethic, often led me to take myself to breaking point,” she says.

An underlying medical condition worsens Emma’s mental health

“In 2009, my parents retired, and I moved into a new place on my own with my girls. I started experiencing severe anxiety, and I consulted a new psychiatrist who diagnosed bipolar disorder. I was devastated. I remember sitting on the back porch crying on the phone to my mom that my life was over. My greatest fear was that my children would be taken away,” says Emma.

“From early 2010 until August 2015, I had severe depression that wasn’t resolving and, to treat it, I had 48 electro-convulsive therapy (ECT) treatments. This means undergoing a mild anaesthetic so that an electric current can be run through your brain to induce a seizure. This is regarded as effective for patients not responding to medication or when the depression is very severe. Initially it worked, but in the last half of 2015, I took a nosedive physically and mentally. I was so ill I couldn’t speak. It was difficult to walk, climb stairs or even sit, but I was still trying to work. I didn’t know what was going on and I could see no way forward physically or mentally. I returned to my first psychiatrist and he had a suspicion there was an underlying physical condition at play.” He turned out to be right.

“We realised by accident that my adrenal glands were not functioning,” explains Emma. “I was put on a course of Prednisone – a corticosteroid – for a chest infection. Within hours, I was able to function. My parents were with me at the time and said it was like someone switched the lights on.” Emma was referred to an endocrinologist for further investigation and monitoring of her cortisol levels. Finally, in May of 2016, when Emma was 36 years old, she was diagnosed with a dysfunction of the hypothalamic-pituitary-adrenal axis. Also known as secondary adrenal insufficiency, this illness means a failure of the adrenal glands to produce enough cortisol, a stress hormone that’s essential for many of the body’s processes – from maintaining blood pressure and cardiovascular function, to regulating the immune system and balancing the metabolism of proteins, carbohydrates and fats.

Cortisol is produced by the adrenal glands, which are regulated by the brain’s hypothalamus and pituitary gland. In Emma’s case, the communication lines between the hypothalamus, pituitary and adrenal glands were not operating effectively. Treatment involved taking hormones to replace those that are missing. “I am at a stage now where I no longer need the cortisol replaced, but I still struggle with dizziness, nausea, severe body pain and fatigue on an almost daily basis,” says Emma. “It can be very hard, and on the days when I can’t function, my mood dips. At these times, it’s useful to practice self-compassion and try to remember that I am good enough, even if I am not always everything I want to be.”

“I owe my life to Discovery Health Medical Scheme”

"I’ve been a Discovery Health Medical Scheme (DHMS) member for years and I can honestly say I owe my life to the scheme’s support,” says Emma. “There have been medical emergencies, psychiatric admissions, ambulance trips and emergency surgeries for me and my girls. DHMS is there for us, and gratitude doesn’t begin to cover what I feel. I didn’t plan on being the worst investment they ever made, but I wouldn’t be here if it weren’t for them!” says Emma.

Emma believes in taking each day as it comes and living a healthy, fulfilling life, despite the challenges. She knows good sleep, good nutrition and regular exercise (she loves to swim) are the cornerstones of physical and mental wellbeing, in addition to taking her medicine exactly as prescribed and following the guidance of healthcare professionals. “What has saved me is access to good healthcare providers who understand me and want the best for me, even when the problems seem insurmountable. Their faith in my abilities and unwavering commitment gives me hope and the strength to carry on,” says Emma. “I often think, if they can believe in me, I can believe in me too.”

Emma’s advice to others living with mental health challenges

Emma explains, “Many people with mental health diagnoses know that it’s generally very tough getting past the ‘he or she is just crazy’ stigma and getting the help we know we need.” She wants others to know the following about mental health diagnoses:

• They are words. They do not define you. You are more than a checklist in a psychiatric textbook. You are more than any box you are told to sit in.
• Mental health diagnoses are illnesses and they can be treated. Even a lifelong diagnosis does not mean that is all you will ever be, and that life will never change.
• There is treatment, there is management, and there is recovery. These are all important steps. But there is also healing, which begins with your relationship with yourself. It begins with having compassion for the human being that you are, before and beyond any diagnosis. Healing is waking up grateful. Healing is holding onto hope. Healing is finding peace with the way things are and finding the miracle in the mire.
• No diagnosis can take away your value and worth, and your life is worth the fight.