'If I Could Just Smile And It'd All Go Away, I'd Do It, But It's Not That Easy'

This is the story of Sarah Hannah, 23, from Glasgow, Scotland.

I was diagnosed with psoriatic arthritis at 16.I had a lot of joint pain, a lot of swelling and stiffness. That was making me really tired, I couldn't do anything, it was making me really miserable. I was on holiday in Vegas with my family, and I was in the shower, and my wrist was so swollen and painful I couldn't turn the tap off. We decided when I got home I needed to go and see a doctor because it was getting quite out of control.

Once my doctor realized what the problem was, it got quite bad quite quickly. It started spreading to lots of different joints, and within about six months I was on all sorts of medication for it. I originally started on an immunosuppressant. It got to the point where that alone wasn't enough, so they added in another one. About two years ago, they put me on a biologic treatment where I give myself injections. That seems to have got things under control. I'm still on the medications, plus about four others now too.

I was really gutted [by the psoriatic arthritis diagnosis]. Some days, I found it incredibly painful even just to walk. I was still in school, so I was trying to keep up with all my classes, but I couldn't concentrate. My friends were starting to drive and becoming very independent, whereas I was relying on my parents to do everything for me. At 18, my friends could go out drinking and clubbing, and I was curling up in my bed.

I believe this is the root of my depression. At the time, I didn't know that's what it was, but when I look but I can see that's kind of when it started. I started on antidepressants when I was 19. I was having a really difficult time at university. The worse my health gets, the harder it gets to cope. I was having a really difficult time where I was studying, about 600 miles from home. I didn't want to do anything. I didn't want to go to classes, I wasn't enjoying anything, I wasn't sleeping. I was at the doctor for something unrelated, and she said, "I think you need to think about going on antidepressants." I was really surprised. I wasn't keen, purely because I didn't think people would really understand. I used to get quite a lot of, "You've got everything going for you, what's wrong with you, why do you need [help]?"

I moved to Spain to study abroad for a year and felt like things were finally getting better. But this last year has been really difficult. I've spent a lot of time in the hospital because I've had a lot of stomach problems. It's really only this year that I find anxiety to be a problem. I find it really difficult to focus on anything when I've got that anxious, heart-about-to-beat-out-of-my-chest feeling. Everything stops.

I've started counseling this last year. Sometimes I think it's really helpful, and sometimes I come away feeling like I maybe haven't gotten much out of it. In the long run, I think I've learned some quite useful skills from it that if I'm in the right frame of mind, I can use. But when I'm in a bad state, I'm too far gone, it doesn't really work for me. It's something I need to work on; they can't do it for me. When I move back to university in September, I'm probably going to continue going.

Everybody has an image of the student at university and it's the best years of your life and the most fun you'll ever have. If I look back, that's really not how I feel. I used to have days where I didn't even want to leave my flat. It's quite isolating. [My university] runs all sorts of societies and socials, but if I'm not having a good day, going out with 100 people I don't know is one of the scariest things. Still, it wasn't all bad. I've made some great friends.

In the last three or four years, my family and friends have maybe got a better understanding. They've been very supportive. My close friends and my boyfriend and my family know everything I've had to deal with over the last few years, so they're very supportive. But to look at me, you would never know I have the arthritis and other health problems, so if I said I actually suffer with depression and anxiety, people kind of don't understand it.

I don't like how people think you can just click your fingers and change it. I really dislike it when people say, "Why don't you just smile?" If I could just smile and it'd all go away, I'd do it, but it's not that easy. I think people think it's more of an attitude problem than an illness. I don't think you really understand it unless you've experienced it. There's not a lot of compassion.

As told to Sarah Klein. This interview has been edited for clarity and length.

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