Featuring Anonymous’ article from the Physician Outlook magazine.

A marathon begins months before the participant ever pins on his or her bib. The preparation is lengthy, tiresome, and trying, but half the battle is convincing oneself that crossing the finish line is worth all the sweat, tears, and strains. Running a marathon is a completely mental game. Mental, a simple adjective that bears more weight for my family than the appearance of this six-letter word. Mental, never separated from mental health: it has metamorphosed from an adjective into a disease, a state of being. Mental health is a battle; my brother’s secretly began months before the pivotal starting point of his race as he unknowingly prepared to run the marathon of a lifetime.

Leading up to that day, there were signs. As he trained and trained to become a high school graduate and transition into adulthood, the voices started. Alone in his room or driving his car the voices accompanied him in the back seat. They became his worst enemy, an inhibitory training partner, sabotaging all his hard work. Like a strong head wind, the voices were there, but invisible to the rest of us. Slowly, breaking down the brother I adored and admired. There were days of tempo runs: quick bursts of sadness and anger. There were days of slow runs: draining, depressing, with no end in sight. A silent killer, his emotions and thoughts began to control his mind. His methodical presence began to fade into the background as his preparation for the upcoming monumental change began to consume our family’s lives. Then race day arrived. High school graduation day: A time of celebration, happiness, anticipation, and change. As the countdown begins, the runners line up at the starting line. The gun fires. Let the marathon begin.

The beginning of a race is always chaotic. Every runner struggles to find his or her pace as each stride is met with the resistance of an overcrowded path ahead. The first major challenge is separating the excitement of the race from the reality. Although one may have excessive energy now, 26.2 miles is a journey, not a sprint. At first, my brother struggled with this separation. “Is what I am feeling just a ‘funk,’ am I depressed, or maybe just anxious to leave home and start college in a foreign place?” Slowly, the harsh reality began to settle in. “These voices are real. My suicidal thoughts are scary. This is not the person I am.” With spectators lining the stage my brother put on a happy face, but once the crowds faded he began unraveling before our family’s eyes. In the calm setting of our home, the breakdown began. At mile three there was an aid station and my brother thankfully stopped for help.  So soon into the race confusion set in and the entire racecourse was altered, as the calculated distance appeared to lengthen in time. The next week, originally filled with celebrations and graduation parties, turned into white walls, visiting hours, fears, and tears...more and more tears.

Most people have never run a marathon. Most people have never been in a psychiatric ward. Envision endless crisp white walls, with no inspiring generic quotations or picturesque destination getaways, no fake plants, or attempts to ease the anxiety of the patients in this unnerving setting. Walking into the psychiatric ward on that sunny June day, my family’s entire world turned to darkness. The next two weeks were a state of dehydrated delirium. This cannot be happening at mile three, not before the race even truly began. Sitting in the parking lot of the hospital, my mother and I sobbed, praying that by a slight miracle this was a false start.

There are always rules and regulations a participant has to follow before any race begins. No baby strollers or iPods, no trail shoes or bare feet. Entering into the psychiatric ward, the rules were not so simple. All shoe laces removed, all edges of papers or pictures rounded, no pants with drawstrings. Need to go to the bathroom? Leave the door open and a nurse will wait outside. Instantly my brother turned into an experiment. Combinations of medicines, with all other variables controlled, observations were taken and data was collected - all in the hopes of continuing the race.

Unfortunately this pit stop lasted two weeks. Two weeks of sleepless nights, constant worry, and unmasked fear. As my brother’s body started to regain nourishment and his dehydrated delirium started to subside, daily visits home were incorporated into our family’s new agonizing “routine.” Finally the doctors released his discharge papers and my brother was able to continue on with the marathon. The next couple of miles were slow with every stride more cautious than the next. Quickly, our family came to the realization that this 26.2-mile endeavor had now become a family affair as we fluctuated between spectating and running alongside him. Our family learned to move with hidden reluctance avoiding any breakdowns, but the breakdowns were unavoidable. Every aid station gave our family false hope. With every two miles gained, another mile would be lost as together we would slowly slug backwards, re-tracking and re-running the now familiar course.

As a marathon spectator your only job is to encourage runners passing by that every painful stride is worth crossing the finish line. As muscles cramp, your digestive system breaks down, and chaffing appears in unimaginable places, runners need every smiling face, every cowbell, and every cheer. As his number one spectators, our “mom and daughter” morning coffee talks turned into a two-way therapy session. A way to re-energize each other mentally and find the strength to continue to cheer, mile after mile. The human body is not designed for this kind of abuse nor is the human mind. As spectators watch runners move into the second half of the race, they question why would someone run 26.2 miles? The anguish on runners’ faces reflects the deterioration of their bodies and minds. Marathon runners will tell spectators that at this pivotal point, one begins to play head games filled with calculations, rationalizations, bargains, and rewards. For most runners, this is where one’s mental will steps in to salvage the race. My brother’s lack of preparation for the marathon left his mental muscle weak midway through the race.

The illness began to engulf the outsiders. Once spectators, we were now running the race, stride by stride. Mental illness became our third family member. Our new partner affected each of us differently along the race. As my mom and I began to run the marathon with my brother, we realized that no one else would really ever understand the depths of our pain. We knew we could not slow down. My mom took her pit stops through the support and comfort of her family and friends. My mom watched from the sidelines, crossing into the race’s path on occasion, cheering, stretching her emotions, drinking extra fluids and continuing to remain hopeful that he would finish the race. My mom still has not lost hope, five years later. Soon thereafter I felt the chaffing. Worry began to engulf my school days with constant phone calls from my mom asking of my brother’s whereabouts and when I had spoken to him last. One too many times my days were cut short as I rushed home, hoping that by a miracle I would find him peacefully taking a nap, instead of the dreaded nightmare that haunted us.

After a year of running, the marathon appeared to become a quest for failure. At this point, it was time for my course to diverge from the team. A new location, a new academic challenge, a new life was before me and I had no choice but to accept this off-road trail. Leaving home for college that August day, anxiety filled every pore of my being. But running a marathon is unstructured and unpredictable, one must learn to adapt to any obstacle before them. So adapting is what our team did. When the time came to return home for fall break I had no idea what to expect. Shock met me at the front door. Welcome home.

Marathons change people - 26.2 miles is a euphoric event. Since my first visit home my stride has adjusted. Today my brother is not the person I grew up with. He is not the same easy-going brother I built Lego castles with in our basement. He is not the same brother I have loved for eighteen years, but he is still my brother.

The main difference between mental health and running a marathon is choice. People who run a marathon choose to run a marathon. People who have mental health disorders never choose this diagnosis. Regardless of the power of choice, people continue to push through the grueling miles of a marathon and people continue to battle their mental health disorders through the relentless and unpredictable challenges. After a marathon, a runner is forever stronger. Stronger, because he or she knows the magnitude of their accomplishment and even when the course seemed unforgiving and endless, they continued to wage forward. Individuals with mental health disorders, although they may never know exactly what waits at the finish line, continue to wake up everyday, ready to run more miles and continue on with the race, gaining strength with every stride.

Every day I go for a run, not a single mile passes that my brother does not accompany me, but I allow him to stride alongside. This is how I process the cruelty of a mental health illness, this is how I mourn the loss of my brother, and this is how I accept the new brother I am so grateful to have and to love. Our family love is unconditional and can easily withstand more than 26.2 miles.