Francesca Pileggi begins her presentation with a photograph of herself, circa age 5, on the first day of school. The look on her face: utter horror.
It's normal to be anxious at such a time, but Pileggi's anxiety ruled her life. When teachers called on her, her throat closed. When she played sports, she'd freeze. Her panic attacks were so severe that she sometimes vomited.
In high school, at Archmere Academy in Claymont, Del., she decided to shed her image as the shy smart girl. So she adopted the mask of the giggly extrovert. Her goal was to become popular, to snag a boyfriend and a first kiss. Then she'd be happy, she figured. In sophomore year, she achieved that "trifecta of coolness," but was still miserable.
When she and her boyfriend broke up, her mental illness took a new turn: deep depression. She wept frequently, withdrew from her friends, ranted at her parents, lost interest in the things she loved, such as playing the harp and throwing the discus. She tried to hide it, continued to excel in school, but she felt like a fraud.
"I thought I was just weak and needed to learn how to suck it up," says Pileggi, who lives in Glen Mills.
Then, in June 2005, Pileggi's cousin hanged himself, three days after graduating from high school. He was a good guy, quiet and sweet, who dreamed of playing football at Penn State. He lived across the street, and Pileggi, a year younger, looked up to him like an older brother.
Pileggi was shattered. She felt guilty - why him and not me? - and was haunted by his ghost. She saw him at church, in public places. She was afraid to open shower stalls and closets, sure he'd be lurking within. She developed a mortal fear of the dark. In the spring of her senior year, she was gripped by a panic attack so brutal she had to be hospitalized, her vital signs sputtering.
Today, Pileggi, 23, a recent graduate of Lafayette College, is poised and vivacious. She still has crying spells, she still feels sad and unworthy at times, but thanks to medication and cognitive therapy, she can cope.
She also has a purpose. Last spring, in honor of her cousin, she launched The ME Project, a hangout and resource center in Chadds Ford for teens struggling with mental illness.
"You can only get so far Googling," Pileggi says. "I wanted to have a concrete place where teens with mental health issues could come and talk and learn and where they wouldn't feel so weird and alone. One in four people struggles with mental health issues at some point in life."
Pileggi also shares her story, with total frankness, as a speaker for Minding Your Mind, an Ardmore-based group also devoted to erasing the stigma of mental illness and encouraging people who need treatment, especially adolescents, to seek it.
Christine Berrettini, executive director of Minding Your Mind, refers to afflictions such as anxiety, depression, and bipolar disorder as "brain diseases."
"Scientists are finding more biological markers for these disorders," says Berrettini, whose husband, Wade, is director of the Center for Neurobiology and Behavior at the University of Pennsylvania and does that very research. "These are real diseases, and there are effective treatments."
For instance, 85 percent of people with bipolar disorder respond to lithium, Berrettini says, and talk therapy can also alleviate brain disease. Unfortunately, only three out of 10 people with mental illness seek treatment, and of those three, only one gets good treatment, Berrettini says. Unlike someone seeking relief from heart disease or an orthopedic defect, people with mental illness too often give up if the first therapist they see can't help.
Minding Your Mind was founded nearly four years ago by entrepreneurs Steven and Amy Erlbaum to dispel the medieval ignorance surrounding mental illness and to make reliable information and assistance readily available, free of charge. MYM's annual forum has featured mental health advocates, authors, actors, and researchers. But most of its outreach is "kids-driven." Says Berrettini. "We use kids to talk to other kids." Why? "Because they listen."
Young-adult speakers such as Pileggi have visited more than 50 middle and high schools in the region, telling their stories and urging teens to talk openly about mental illness, to recognize its signs, and to resist the lethal glamour of suicide, "a permanent solution to a temporary problem," in Pileggi's words.
The onset of mental illness seems to be occurring earlier, research shows. It used to emerge around age 18, Berrettini says; now it's happening at 14.
"We want to get kids at the age of onset," Berrettini says, "because indications are that the earlier the treatment, the less severe and frequent the illness will be over the course of time."
Still, the stigma of mental illness persists. "People are really scared," Berrettini explains. "They're afraid it could happen to them."