Please Fix Me: A Conversation with Anna Mehler Paperny

ANNA MEHLER PAPERNY does not want anyone to commit suicide. Her new book, Hello I Want to Die Please Fix Me: Depression in the First Person, extends a warm hand to anyone who’s feeling what she has been through. But for people who are absolutely determined to try self-harm, she has a few solid suggestions they might want to consider.

“If you’re ever picked up by police and carted off to the hospital in the middle of the night,” she writes in the book, 

I recommend bringing a warm sweater and a good book (cell charger, wallet, writing implements and health card are also worthwhile accessories). I, short-sighted fool, was wearing the previous day’s skirt, a T-shirt and a thin raincoat. […] The crisis ward was dark and bare and cold and I was bored out of my mind.

A second tip: “Don’t try paint thinner. Even after expelling everything I could I was burping solvent all night and much of the following morning.” And yet more good advice: “Do not, ever, get your period in the crisis ward.” After overdosing on hundreds of anti-depressant pills, it was some time before Mehler Paperny emerged from the fog. For a while, she could not remember the word “tampon.”

It is with this uniquely dark humor that Mehler Paperny breaks the ice. Hello I Want to Die Please Fix Me recounts her journey from an unconscious position on her kitchen floor to a psych ward in Toronto and then through Canada’s “labyrinthine psychiatric care system via the trapdoor of botched self-obliteration.” An award-winning journalist previously with the national Globe and Mail newspaper and now with Reuters, Mehler Paperny applies a reporter’s curiosity to her own story. The result is a profoundly intimate, well-researched, funny, and, above all, nakedly honest exploration of depression and suicide, and a survey of our best attempts to understand and address mental illness.

Mehler Paperny investigates the effectiveness of mainstream treatments for depression, such as cognitive-behavioral therapy and neurotransmitter reuptake inhibitors. She presents expert opinion on more controversial approaches, including electroconvulsive therapy and anterior cingulotomy procedures. She explores entirely experimental methods — the potential therapeutic applications of psychedelic drugs like magic mushrooms, for example, or Google’s algorithmic approach, which might one day let your smartphone diagnosis you (a prospect with which Mehler Paperny notes she is less than thrilled). The reader is introduced to dozens of clinicians, researchers, and every pharmaceutical representative who would agree to an interview (which, unfortunately, was not many). All the while, Mehler Paperny is riding her own “psychopharmacological merry-go-round,” trying no less than 14 medications administered in many combinations. “Some drugs made me trembly, some made me antsy, one made me sweaty,” she writes. “One made me sneeze endlessly; some made me nauseous, especially on an empty stomach, especially with an espresso on an empty stomach.”

Mehler Paperny recently spoke to me about her new book, her struggle with severe depression, and the decade she has spent learning as much as she can about the mental illness that affects her and so many others.

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TRAVIS LUPICK: Hello I Want to Die Please Fix Me is often more about suicide than depression. I find that rare among books about mental health, because we don’t talk a lot about suicide. Was that intentional? What was your intent with such a focus on suicide?

ANNA MEHLER PAPERNY: I do think it is unusual to find a book that’s about suicide. I think we still tend to shy away from it. In my case, the book is about suicide because that is where my experience lays. The personal stuff is suicide. And so that was also where a lot of my questions were, in terms of what we know about how it works, and what works and doesn’t work in terms of treatment. That’s why I ended up focusing on suicide. And because, I guess, I tried not to pay attention to that voice that asks you, “What the hell are you doing?”

As a journalist whose job it is to write about the lives of others, how terrifying was it to share this much of your personal life and of your own story?

It was so terrifying. It was more terrifying once we got to the editing stage, because that’s when my editor started asking important and tough questions, forcing me to interrogate my own experiences in ways I hadn’t before. I was like, “What am I doing? What have I done? Is it too late to go back on this? Is it too late to change my mind?” But I felt like I had to continue. In order for it to be worthwhile, I really needed to bite the bullet and let it all hang out.

Even earlier, how did you arrive at the decision to write a book in the first person?

I had started to write about my own experiences in little bits and snatches, almost as a cathartic exercise. So, in the beginning, I just had little snippets of writing. And then I found that I had a lot of questions about what I was going through that weren’t answered in other books. And I figured that other people might also have those questions.

I wanted to ask these questions that I had. I figured that if I was going to keep writing little bits, maybe I could string them together into something coherent. And then I wanted something that was true to what I was going through, in terms of tone, and in terms of the kinds of questions that I would ask.

My favorite parts of the book are where you include practical advice. Not on how to commit suicide, of course, but advice on what people might want to think about if they are determined to commit suicide. For example, charge your phone, because there’s a chance you might not die, and if you don’t die, you’re going to be stuck in the hospital for a while and probably very bored. I found these bits lightened the mood and made a heavy topic easier to digest. But does such talk run the risk of making light of suicide? What do you say to people who criticize the book for talking about suicide so casually?

The response has been pretty good, so far. Or maybe the people who are pissed just haven’t told me. But I feel like humor bypasses a lot of the awkwardness that people tend to treat this issue with. Humor forces you to be frank and forces you to tackle something directly. And so, I found it to be a really useful tool in terms of getting past people’s barriers.

Researching this book was obviously a journey of education for you. What was the most surprising thing you learned? What is the favorite thing you learned?

The most surprising thing I learned was just how little we actually know about depression and suicide. That floored me. We don’t know where it comes from, we don’t know what creates it, we don’t know how the drugs work, we don’t know how any of our treatments work. It was like, “Seriously? This is where we’re at?”

In terms of things that were fun, I got to visit brain banks. That was really cool. I got to hold people’s brains. That was fun. We don’t pickle brains very often anymore. It’s not the most practical thing to do if you want to study them. But I really liked it.

Popular authors like Johann Hari have brought a lot of attention to environmental explanations for anxiety and depression, which you don’t give a lot of space to in your book. Instead, you focus on biology and neurology. Why is that? What are your thoughts on environmental factors and the extent to which they contribute to mental illness? 

I find it really interesting. But the reason it’s not included in the book is because I find there’s still a lot of supposition. I feel like we don’t really know enough about it [environmental factors], or that we don’t know enough about it that I know what I would say. I feel like we’re still a little bit lost in that regard. It’s really interesting, but I think there is still a long way to go in terms of crafting plausible hypotheses.

Let’s talk about mental health and civil liberties. You have unique insight on institutionalization, given your firsthand experience. What are your thoughts on North America’s process of deinstitutionalization that occurred from the 1960s to the 1980s? Should we confine people against their will for mental health reasons?

I think it’s become trendy to get nostalgic about institutionalization and think, “Those were the good ol’ days, when we had more spaces in mental hospitals and when we had places to put people for extended periods of time.” We tend to forget that those institutions drastically abrogated people’s rights, with impunity. It’s hard. Because it is true that we don’t really have spaces right now for people who do need to be institutionalized, in some form. But I think that we need to approach that by being really humble about our assumptions. It’s often too easy a solution to arrive at, to say, “This person needs to be locked away.” That might be the simplest solution but not always the most compassionate or the most effective. I think it might be more challenging but more important to treat people as collaborators.

Is there a right way to do institutionalization?

I think it needs to be looked at as a last resort and I think it needs to be looked at as something that should be voluntary, whenever possible. And I think you can arrive at that by making institutionalization less awful, by making the institution itself something that is not horrible, by making the place and the environment and the food not awful. And, by doing so, I think you can create a situation where you might, in concert, decide that this is the best option for somebody, rather than automatically going to the coercive option.

Sticking with the topic of civil liberties, can you explain how mental health calls are recorded in police databases? That’s something I think many people might never have thought of before. What are the effects, for someone who is struggling with their mental health, of police logging calls that are not of a criminal nature?

We’ve seen the consequences in Canada most clearly when a police force logs a suicide attempt and that call comes up, years later, when that person tries to travel to the United States. People have actually been refused entry for that reason. That’s an extreme example, but it shows us the importance of not criminalizing mental illness and incidents related to mental illness, and the delicate balance that police need to play. Because, increasingly, police are playing a really big role in responding to mental illness. Whether that’s a good thing or a bad thing depends on what you see as the ideal response and what role you see the police playing. But right now, that’s what they do. So, if they are going to respond to a mental health crisis, they need to respond to and treat it like a health issue and not like a criminal matter.

Police are not always great at treating an incident as anything but a criminal matter.

Right, because police are trained to go fast, to not take “no” for an answer, to not ask questions but give demands. All of those things can be good if they are trying to intercept a suspect in a crime. But they can be really bad if police are trying to talk someone down off a cliff. It requires changes to their instincts and how they’ve been trained.

The book was first released in your home country of Canada. What’s been the response? What sort of questions are you asked, and how do you respond?

A lot of people say, “Oh my god, this book really spoke to my experience,” or, “I went through something similar.” That’s tough to hear. I want to say, “I’m so sorry,” or, “Thank you,” or, “I’m glad you liked it.” Because a lot of people who have been through something similar have never really had the opportunity to see themselves reflected in anything they’ve read before. And so, I am gratified that they have found this book helpful. But it kills me that this is something that we are still so bad at talking about, that these people were waiting for a book to speak to them like that.

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Travis Lupick, a journalist based in Vancouver, is the author of Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction (2018). Follow him on Twitter: @tlupick.