To You Who Don’t Understand mental health, this is for you
Naomi-Nicole Bramer on sharing her battle with depression and chronic illnesses, one letter at a time.

CW: Suicide, mental illness, depression, anxiety

To You Who Don’t Understand,

I mean no offense. I meant that in the nicest way possible, which is why I write you this letter. To maybe help you understand, even if just a little bit better. But for all of us who do understand, who must live with the experience, I will try to explain it on our behalf. And so, You Who Do Not Understand, I write this letter to you.

Naomi-Nicole Bramer wrote that letter out of frustration when she was a teenager. She wanted her friends, family, parents, brother, sister, and boyfriend at the time to understand what it’s like to live with depression. They always told her that she didn’t have a reason to be depressed and anxious; that she hadn’t experienced any childhood trauma; that she grew up in a happy and loving home.

The letter is part of her book titled To You Who Don’t Understand, a collection of short stories, poems, and letters. Bramer admits that she never had any intention of sharing it with anyone. “If you asked me 15 years ago, there’s no way I’m writing a book on mental health,” she says. “I hated the stigma of being labelled as depressed, so I hid it for most of my life.”

Bramer grew up in a very Christian home. According to her, depression and anxiety aren’t looked well upon. “I don’t think my parents understood [my illnesses]. It was hard to tell them I needed help,” she states.

Depression is one of the most common mental illnesses worldwide. It negatively affects how a person feels, thinks, and acts. According to the American Psychiatric Association, depression leads to symptoms that vary from mild to severe. These include feeling sad, losing interest or pleasure in activities once enjoyed, loss of appetite, difficulty in concentrating, and thoughts of death or suicide.

Factors that play into depression include genetics, biochemistry, personality, and environmental surroundings. Individuals suffering from depression may have chemical imbalances in the brain, be overwhelmed by stress, or be exposed to continuous violence, neglect, abuse, or poverty. However, the illness can affect everyone—even if the individual lives a seemingly ideal life.

When Bramer was in high school, she was diagnosed with depression and anxiety. Her doctors at the time predicted she had been struggling with the illness since the age of 13. “There were some days where it was hard to get out of bed and [my family] told me to just ‘Get out of bed. Stop being lazy. Force yourself to do something,’” recalls Bramer. “You just say ‘get out of bed,’ but you don’t understand that it feels like a thousand weights on me.”

Despite struggling with depression, Bramer graduated as an Ontario scholar from Queensway College—a private high school that encourages its students to seek undergraduate studies post-graduation. She chose the University of Toronto Mississauga (UTM) due to its prestigious reputation.

In the fall of 2006, she started her undergraduate journey by studying theatre, drama, and English—though she didn’t stick to that plan for long. Bramer’s cousin, who also went to UTM, advised her to take Professor Guy Allen’s WRI203: Creative Writing course. “She knew that I liked writing and that I was already in the English program, the only program that I knew was close to writing,” chuckles Bramer.

She achieved one of her highest marks in that course. So much so, Professor Allen asked her if she would like to join the professional writing and communication (PWC) major. Things were going great for her. She had found her place within the UTM community and gained the respect of her professors. But then, her physical health struggles took a massive toll on her mental health—one that would force her to take a seven-year break.

Bramer started experiencing stomach problems, sleep problems, fatigue, and emotional and mental distress. After multiple tests, she was diagnosed with gastroparesis and fibromyalgia. Gastroparesis prevents the stomach from digesting food properly. Individuals who suffer from it experience weight loss, lack of appetite, nausea, vomiting, and abdominal pain and bloating. Fibromyalgia, on the other hand, is a form of chronic illness that causes pain all over the body. Bramer later found out she also had lupus, an autoimmune disease that attacks the body’s tissues and organs.

“It’s been a long road. The thing with autoimmune diseases is that they’re very hard to diagnose,” she explains. “I had two misdiagnoses where doctors told me it was something and then more symptoms presented themselves.”

Bramer’s snowball effect of problems isn’t rare. In February 2021, the Canadian Institute for Health Information released their annual survey titled How Canada Compares. In it, they found that 63 per cent of Canadians with a mental health condition also reported having another chronic condition. Mental health illnesses like depression and anxiety are often symptoms of chronic illnesses.

In her first two years out of school, Bramer wasn’t able to hold down a job. She was in-and-out of hospitals, visiting a lot of doctors, and taking multiple blood tests. “Autoimmune diseases are like a rollercoaster,” states Bramer. “You have something called a ‘flare up,’ which makes you really sick. But then six months or a year later, you can be almost symptom-free.”

Three years after dropping out, Bramer felt better with the help of anti-depressants, anti-anxiety pills, and a cocktail of medicines, steroids, and pain killers. However, she still wasn’t confident enough to return to her studies. In order to get back into the groove, Bramer took a 0ne-year college certificate course at Bronte College to become a special needs teacher. She later landed a full-time position at Philopateer Christian College (PCC) and held it for the next four years.

Even though she enjoyed her time at PCC, the job was very physically demanding. “I realized that I wouldn’t be able to do that for the rest of my life because I have a chronic pain disease. If I wanted to move up in the job, I had to get another certification because I didn’t have a degree,” explains Bramer. She was split between two decisions: pursue a new certification or go back to UTM and finish her studies. She chose the latter.

“It was very different being back in university when all of my friends that I had known were graduated,” recalls Bramer. She was 28 years old when she came back. “I felt very behind. I think that affected my confidence level. I thought ‘I’m so old, maybe I don’t belong here anymore.’ But as I got into it, I gained my confidence back.”

When she first attended UTM, Bramer didn’t take school too seriously. Coming directly from a private school, she faced a lot of freedom and partied often. Seven years later, her priorities were straight; she knew exactly what she wanted to do. Bramer switched her programs for the last time to a history and PWC double major, and an English minor. She took three courses per semester (the minimum amount UTM allows to be registered as a full-time student) in order to “do it right.”

Bramer liked being back on campus, as she had access to UTM’s mental health clinic. However, she notes that it was very difficult to get appointments on campus. Like many students, she experienced long wait times before seeing a counselor. “But to be fair, that’s also been my experience out in the real world. I don’t think it’s just UTM. Even now as a full-time working adult, if you want to see a psychiatrist or counselor, there’s long waitlists,” she shares.

Indeed, the Canadian Institute for Mental Health Information also found that less than half of Canadians who want help for their mental health concerns receive services. The reason? There aren’t enough health professionals to meet the rising demand—despite Canada spending $51 billion annually on mental health care costs.

Bramer found that what helped her most was booking appointments ahead of time at the UTM clinic. “It works out better if you try to book continuous appointments,” she adds. “Even if you think you’re fine, even if you are in the best point of your life during a certain moment, keep your appointments or still book an appointment. Think of it as an upkeep, like doctors who have regular checkups. You’re perfectly fine, but you still go in for physicals.”

Things were going well yet again for Bramer in her second round at UTM. She reconnected with Professor Allen and enrolled herself in his WRI420: Making a Book course after he recommended her to do so. Bramer spent a semester writing about the Japanese Bushido as part of her book’s manuscript. Around that time, another cousin who worked at a youth centre reached out.

“She approached me and said, ‘I’m having a lot of youth come to me and they’re struggling with depression—and I don’t know. I’ve never had it. But I know you struggled with it. Do you have any advice for somebody like me who doesn’t understand?’” recalls Bramer.

She shared the letter she wrote out of frustration with her cousin. Two weeks later, her cousin came back and told Bramer that she wanted to share it with her team. Bramer was shocked. She rejected the idea. Some of the people that her cousin worked with were family and friends. But eventually, Bramer agreed to share the letter with one condition: the author must be kept anonymous. “I didn’t want my name attached to it, but I figured if it was going to help people, then great.”

Months passed and Bramer’s cousin returned with some news: the team was eager to learn who wrote the letter. They wanted more from the author. Bramer still felt uncomfortable and rejected to share her identity—but then she learned someone close to her had attempted to take their own life.

Her friend was rushed to the hospital. There, “the one thing she kept saying was ‘nobody understands. Nobody understands,’” recalls Bramer. “It really just broke my heart because she didn’t think anybody understood what it’s like to feel like that. I told her, ‘I understand. I understand what it feels like to be there.’ If I had been more open about my experience and not been so embarrassed or hid it, would I have been able to help her? If she had been successful in taking her life and the reason was that nobody understood her, then I would not have been able to live with myself.”

This moment, along with her letter being passed around, made Bramer change the topic of her book: one that would help people understand what it’s like to live in the shoes of a person with depression. “All the social stigma that is put on mental health and depression is not worth the life of somebody I care about. I was feeding into the mental health stigma,” explains Bramer.

She revisited her journal and picked out poems she had written in her teens to show what the mind of a depressed and anxious teenager looks like. “I almost gave up writing that book so many times with every story, every edit,” concludes Bramer. “It was hard. I had to keep reliving some of the worst moments of my life. [But] I kept thinking back about the one person close to me who said nobody understood her. I didn’t want anyone else feeling that way.”

To You Who Might Understand (even if momentarily),

Some advice: reach out. I know, scary right? It may seem like you’re in this alone, but there is always someone. A family member, a friend, a guidance counsellor, a help line… There is always someone. They may not understand what you’re going through, but please be patient. It’s difficult for them too. And remember, sometimes you don’t actually need someone who understands, you just need someone who wants to be there for you.